Provider Demographics
NPI:1053352880
Name:KIRBY, KRISTIE L (PHD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-0059
Mailing Address - Country:US
Mailing Address - Phone:615-451-4511
Mailing Address - Fax:615-230-8585
Practice Address - Street 1:919 SUNNY HILL RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6709
Practice Address - Country:US
Practice Address - Phone:615-661-0235
Practice Address - Fax:615-507-2041
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001087103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling