Provider Demographics
NPI:1073196457
Name:KIRI, SOPHIA ISABELLE (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ISABELLE
Last Name:KIRI
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:MRS
Other - First Name:SOPHIA
Other - Middle Name:ISABELLE
Other - Last Name:BESUNDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LMHC
Mailing Address - Street 1:3110 ROYAL WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2629
Mailing Address - Country:US
Mailing Address - Phone:561-577-6202
Mailing Address - Fax:
Practice Address - Street 1:3110 ROYAL WINDSOR DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2629
Practice Address - Country:US
Practice Address - Phone:561-577-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty