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NPI Code Detail

MEDICARE: JIM KIRK, EDS, MFT

MEDICARE: JIM KIRK, EDS, MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor937-LNV
2106H00000XMarriage & Family Therapist556NV

General Provider Information

NPI Number : 1023280120
Entity Type Code : Organization
Provider Name (Legal Business Name) : JIM KIRK, EDS, MFT
Provider Business Mailing Address
First Line : 1005 FOREST ST
Second Line :
City : RENO
State : NV
Zip : 89509-2706
Country : US
Telephone Number : 775-329-4582
Fax Number :
Provider Business Practice Location Address
First Line : 1005 FOREST ST
Second Line :
City : RENO
State : NV
Zip : 89509-2706
Country : US
Telephone Number : 775-329-4582
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. JAMES L KIRK
Credential : MA, EDS
Telephone Number : 775-329-4582
Provider Enumeration Date : 03/28/2008
Last Update Date : 03/28/2008

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