MEDICARE: MICHELLE B KIRBY LCSW

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
1	1041C0700X	Clinical Social Worker	LSW0000003948	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4015779	OTHER	TN	BCBS PARADIGM INC

General Provider Information

NPI Number	:	1225110364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE B KIRBY LCSW

Provider Business Mailing Address
First Line	:	403 PRINCETON RD
Second Line	:	SUITE 2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2056
Country	:	US
Telephone Number	:	423-283-9182
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 PRINCETON RD
Second Line	:	SUITE 2
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2056
Country	:	US
Telephone Number	:	423-283-9182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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