Provider Demographics
NPI:1629797493
Name:KIRKBRIDE, ELENA (LPC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26863 CARRONADE DR APT 11301
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6437
Mailing Address - Country:US
Mailing Address - Phone:419-360-3918
Mailing Address - Fax:
Practice Address - Street 1:164 W WATER ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1332
Practice Address - Country:US
Practice Address - Phone:419-707-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health