Provider Demographics
NPI:1477126340
Name:KIRBY, SHYANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHYANNA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHYANNA
Other - Middle Name:
Other - Last Name:VANMETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3 OAK DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5635
Mailing Address - Country:US
Mailing Address - Phone:618-972-1568
Mailing Address - Fax:618-205-3561
Practice Address - Street 1:3 OAK DR STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5635
Practice Address - Country:US
Practice Address - Phone:618-972-1568
Practice Address - Fax:618-205-3561
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL150105411104100000X
IL149.0266481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker