Provider Demographics
NPI:1477066322
Name:KIRKLIN, CALVIN J (PHD,LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:J
Last Name:KIRKLIN
Suffix:
Gender:M
Credentials:PHD,LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16520 SW UPPER BOONES FERRY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7659
Mailing Address - Country:US
Mailing Address - Phone:503-783-8398
Mailing Address - Fax:971-612-0476
Practice Address - Street 1:16520 SW UPPER BOONES FERRY RD STE 240
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7659
Practice Address - Country:US
Practice Address - Phone:971-240-4025
Practice Address - Fax:971-612-0476
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1911138101Y00000X
TX88695101Y00000X
ORC6865101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1477066322Medicaid