Provider Demographics
NPI:1679765689
Name:NAVE, KIRBY L (MED)
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:L
Last Name:NAVE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 SW YELLOWTAIL LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-6403
Mailing Address - Country:US
Mailing Address - Phone:541-450-3808
Mailing Address - Fax:
Practice Address - Street 1:1590 SE N ST STE C
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3905
Practice Address - Country:US
Practice Address - Phone:541-450-3808
Practice Address - Fax:800-846-8101
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional