Provider Demographics
NPI:1891805180
Name:IRBY, JAMES W JR (PHD, ABPP-CN)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:IRBY
Suffix:JR
Gender:M
Credentials:PHD, ABPP-CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 I 55 NORTH
Mailing Address - Street 2:HIGHLAND VILLAGE SUITE 234
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-982-8531
Mailing Address - Fax:601-982-1115
Practice Address - Street 1:4500 I 55 NORTH
Practice Address - Street 2:HIGHLAND VILLAGE SUITE 234
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-982-8531
Practice Address - Fax:601-982-1115
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS41669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01081821Medicaid
MS680000275Medicare ID - Type Unspecified
MS01081821Medicaid