Provider Demographics
NPI:1235533746
Name:KIRKHAM, DALE (LPC MHSP)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:KIRKHAM
Suffix:
Gender:M
Credentials:LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HARPETH VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-9047
Mailing Address - Country:US
Mailing Address - Phone:615-420-0201
Mailing Address - Fax:
Practice Address - Street 1:2021 21ST AVE S
Practice Address - Street 2:ROOM 322
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4342
Practice Address - Country:US
Practice Address - Phone:615-420-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional