Provider Demographics
NPI:1164967600
Name:KIRBY, ZORA
Entity Type:Individual
Prefix:
First Name:ZORA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 HAMPSHIRE RD
Mailing Address - Street 2:108
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2379
Mailing Address - Country:US
Mailing Address - Phone:805-405-1856
Mailing Address - Fax:805-497-1616
Practice Address - Street 1:699 HAMPSHIRE RD
Practice Address - Street 2:108
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2379
Practice Address - Country:US
Practice Address - Phone:805-405-1856
Practice Address - Fax:805-497-1616
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist