Provider Demographics
NPI:1972998953
Name:KIRK CONSULTING LLC
Entity Type:Organization
Organization Name:KIRK CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-924-2885
Mailing Address - Street 1:P.O. BOX 6085
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3296
Mailing Address - Country:US
Mailing Address - Phone:229-924-2885
Mailing Address - Fax:
Practice Address - Street 1:1508 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3296
Practice Address - Country:US
Practice Address - Phone:229-924-2885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 0002475302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization