Provider Demographics
NPI:1265662464
Name:KIRBY, CAMILLEA (MACL)
Entity Type:Individual
Prefix:
First Name:CAMILLEA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MACL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:405-826-4573
Mailing Address - Fax:
Practice Address - Street 1:550 24TH AVE NW
Practice Address - Street 2:SUITE G
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6310
Practice Address - Country:US
Practice Address - Phone:405-826-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor