Provider Demographics
NPI:1174640130
Name:KIRBY, SALLIE (MS)
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 MARINER LOOP
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-7530
Mailing Address - Country:US
Mailing Address - Phone:530-671-2470
Mailing Address - Fax:
Practice Address - Street 1:2195 BLEVIN RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-1401
Practice Address - Country:US
Practice Address - Phone:530-822-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool