Provider Demographics
NPI:1619158656
Name:KIRK, KAREN KAY (MSSA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:KIRK
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 SHELBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5459
Mailing Address - Country:US
Mailing Address - Phone:330-678-9235
Mailing Address - Fax:
Practice Address - Street 1:2161 EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2179
Practice Address - Country:US
Practice Address - Phone:330-798-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI9386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health