Provider Demographics
NPI:1235407461
Name:KIRK, JAY LEE (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:LEE
Last Name:KIRK
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NOXON AVE
Mailing Address - Street 2:
Mailing Address - City:NOXON
Mailing Address - State:MT
Mailing Address - Zip Code:59853-9762
Mailing Address - Country:US
Mailing Address - Phone:406-847-2442
Mailing Address - Fax:406-847-2232
Practice Address - Street 1:300 NOXON AVE
Practice Address - Street 2:
Practice Address - City:NOXON
Practice Address - State:MT
Practice Address - Zip Code:59853-9762
Practice Address - Country:US
Practice Address - Phone:406-847-2442
Practice Address - Fax:406-847-2232
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health