Provider Demographics
NPI:1710428099
Name:BRASH, KIRBY E (BS)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:E
Last Name:BRASH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:
Other - Last Name:BINT THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 S JOHNSON ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1658
Mailing Address - Country:US
Mailing Address - Phone:248-975-4294
Mailing Address - Fax:248-333-7254
Practice Address - Street 1:1200 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1032
Practice Address - Country:US
Practice Address - Phone:248-975-4294
Practice Address - Fax:248-333-7254
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)