Provider Demographics
NPI:1437778602
Name:KINNEY, KIRKLIN (LPC, PS, ADCII)
Entity Type:Individual
Prefix:
First Name:KIRKLIN
Middle Name:
Last Name:KINNEY
Suffix:
Gender:M
Credentials:LPC, PS, ADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 W SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5327
Mailing Address - Country:US
Mailing Address - Phone:907-376-2411
Mailing Address - Fax:907-352-3363
Practice Address - Street 1:5801 E BOGARD RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-4267
Practice Address - Country:US
Practice Address - Phone:907-352-3252
Practice Address - Fax:907-352-3373
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK141946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK141946OtherSTATE OF ALASKA