Provider Demographics
NPI:1851330435
Name:KIRK, JOHN W (PSYD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KIRK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2086
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2086
Mailing Address - Country:US
Mailing Address - Phone:303-444-3443
Mailing Address - Fax:970-221-3730
Practice Address - Street 1:2501 WALNUT ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5751
Practice Address - Country:US
Practice Address - Phone:303-915-0108
Practice Address - Fax:303-443-4682
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist