Provider Demographics
NPI:1689699951
Name:OXENREIDER, KIRBY (LPC)
Entity Type:Individual
Prefix:MR
First Name:KIRBY
Middle Name:
Last Name:OXENREIDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 W FRYE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6279
Mailing Address - Country:US
Mailing Address - Phone:480-524-0990
Mailing Address - Fax:
Practice Address - Street 1:2081 W FRYE RD STE 208
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6279
Practice Address - Country:US
Practice Address - Phone:480-524-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8329OtherUPMC
PA1674292OtherBC/BS