Provider Demographics
NPI:1518382266
Name:KIRKSEY, RANDY S (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:S
Last Name:KIRKSEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 FARNSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-7208
Mailing Address - Country:US
Mailing Address - Phone:228-990-7645
Mailing Address - Fax:
Practice Address - Street 1:912 CONVENT AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-4334
Practice Address - Country:US
Practice Address - Phone:228-990-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSW2000104100000X
MST01815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker