Provider Demographics
NPI:1568068047
Name:KIRBY, DEANA DENAE (MA, BCC)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:DENAE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MA, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5678 MESQUITE WOODS
Mailing Address - Street 2:
Mailing Address - City:SAINT HEDWIG
Mailing Address - State:TX
Mailing Address - Zip Code:78152-3616
Mailing Address - Country:US
Mailing Address - Phone:210-859-2366
Mailing Address - Fax:210-593-9751
Practice Address - Street 1:4230 GARDENDALE ST STE 502
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3699
Practice Address - Country:US
Practice Address - Phone:210-859-2366
Practice Address - Fax:210-593-9751
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61537101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral