Provider Demographics
NPI:1114093176
Name:SHIRK, KIM (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:SHIRK
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410B SE 3RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2842
Mailing Address - Country:US
Mailing Address - Phone:816-525-5333
Mailing Address - Fax:816-525-5334
Practice Address - Street 1:410B SE 3RD ST STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2842
Practice Address - Country:US
Practice Address - Phone:816-525-5333
Practice Address - Fax:816-525-5334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001021092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497517904Medicaid
MO900112933Medicare UPIN