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General NPI Number Information
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NPI Number | 1659869931
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Entity Type | Individual
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Provider Name | MS. JESSICA LAUREN KIRKLAND
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 500 FAIRWAY DR STE 102
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441
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Country | US
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Telephone | 754-264-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 W ESPLANADE AVE APT 416
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City | KENNER
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State | LA
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Zip | 70065-4943
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Country | US
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Telephone | 225-937-3503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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