Provider Demographics
NPI:1669504577
Name:KIRKSEY, KARON L (LMSW-ACP)
Entity Type:Individual
Prefix:
First Name:KARON
Middle Name:L
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:LMSW-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16319 CAIRNWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2847
Mailing Address - Country:US
Mailing Address - Phone:281-855-7644
Mailing Address - Fax:
Practice Address - Street 1:16319 CAIRNWAY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2847
Practice Address - Country:US
Practice Address - Phone:281-855-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C6766Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXR97502Medicare UPIN