MEDICARE: KIRK COUNSELING LLC

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	101Y00000X	Counselor	67191	TX

General Provider Information

NPI Number	:	1992161236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRK COUNSELING LLC

Provider Business Mailing Address
First Line	:	329 OAKS TRL
Second Line	:	SUITE 132
City	:	GARLAND
State	:	TX
Zip	:	75043-4092
Country	:	US
Telephone Number	:	972-916-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 OAKS TRL
Second Line	:	SUITE 132
City	:	GARLAND
State	:	TX
Zip	:	75043-4092
Country	:	US
Telephone Number	:	972-916-9396
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KIMBERLY KIRK
Credential	:	LPC
Telephone Number	:	972-916-9396

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	12/31/2015

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