Provider Demographics
NPI:1326608639
Name:KIRBY, CASSANDRA L (LPCC)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:L
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 TRANSFER RD STE 21
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1489
Mailing Address - Country:US
Mailing Address - Phone:651-728-0986
Mailing Address - Fax:612-333-5614
Practice Address - Street 1:762 TRANSFER RD STE 21
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-728-0986
Practice Address - Fax:612-333-5614
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health