Provider Demographics
NPI:1972124782
Name:KIRBY, LISA (LPC, MFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LPC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17216 WOOD ACRE TRL
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2732
Mailing Address - Country:US
Mailing Address - Phone:216-509-9011
Mailing Address - Fax:
Practice Address - Street 1:14161 W RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-8953
Practice Address - Country:US
Practice Address - Phone:440-529-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor