Provider Demographics
NPI:1932644085
Name:KIRBY, JACQUELYN (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:KIRBY
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 1:2020 E 70TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5332
Mailing Address - Country:US
Mailing Address - Phone:318-564-2493
Mailing Address - Fax:318-300-3983
Practice Address - Street 1:2020 E 70TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5332
Practice Address - Country:US
Practice Address - Phone:318-564-2493
Practice Address - Fax:318-300-3983
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional