Provider Demographics
NPI:1629661970
Name:KIRKWOLD, SHELBY A (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:A
Last Name:KIRKWOLD
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4644
Mailing Address - Country:US
Mailing Address - Phone:320-202-1400
Mailing Address - Fax:
Practice Address - Street 1:110 14TH AVE E
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4644
Practice Address - Country:US
Practice Address - Phone:320-202-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02633101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)