Provider Demographics
NPI:1417306333
Name:KIRBY, ANDREA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N WHITE CHAPEL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4327
Mailing Address - Country:US
Mailing Address - Phone:817-381-5259
Mailing Address - Fax:
Practice Address - Street 1:1340 N WHITE CHAPEL BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4327
Practice Address - Country:US
Practice Address - Phone:817-381-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical