Provider Demographics
NPI:1003425687
Name:KIRKLAND, CASEY JOHN
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JOHN
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHENEY RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 CHENEY RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3402
Practice Address - Country:US
Practice Address - Phone:541-213-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty