Provider Demographics
NPI:1710048186
Name:KIRK, LYNDA P (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:P
Last Name:KIRK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BRADY LANE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-327-2569
Mailing Address - Fax:512-327-5322
Practice Address - Street 1:3624 NORTH HILLS DRIVE
Practice Address - Street 2:SUITE # B-205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-794-9355
Practice Address - Fax:512-794-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2435207OtherAETNA HMO PIN
TX7633005OtherAETNA PPO-PIN
TX74-2842143OtherTAX PIN
TX742842143OtherHUMANA PPO & HMO PIN