Provider Demographics
NPI:1063650174
Name:KIRKLAND CLINICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:KIRKLAND CLINICAL ASSOCIATES LLC
Other - Org Name:KCA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MS, LPC-S RPT-S
Authorized Official - Phone:972-231-2555
Mailing Address - Street 1:331 MELROSE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4405
Mailing Address - Country:US
Mailing Address - Phone:972-231-2555
Mailing Address - Fax:
Practice Address - Street 1:331 MELROSE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4405
Practice Address - Country:US
Practice Address - Phone:972-231-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11854101YM0800X, 101YP2500X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty