Provider Demographics
NPI:1558074849
Name:KIRBY, MISTY WILLIAMS (MS, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:WILLIAMS
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 MATTHEW CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1453
Mailing Address - Country:US
Mailing Address - Phone:859-539-6078
Mailing Address - Fax:
Practice Address - Street 1:4713 MATTHEW CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1453
Practice Address - Country:US
Practice Address - Phone:859-539-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2575721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical