Provider Demographics
NPI:1851801344
Name:WOOD, KIRBY BLAIR (LPC)
Entity Type:Individual
Prefix:MISS
First Name:KIRBY
Middle Name:BLAIR
Last Name:WOOD
Suffix:
Gender:F
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:PO BOX 65737
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-5681
Mailing Address - Country:US
Mailing Address - Phone:806-305-2012
Mailing Address - Fax:
Practice Address - Street 1:4601 50TH ST STE 108A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3513
Practice Address - Country:US
Practice Address - Phone:806-305-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74244101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional