Provider Demographics
NPI:1023856192
Name:KIRK, ALEXIS BRIANNA (LLPC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIANNA
Last Name:KIRK
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OTTAWA AVE NW APT 704
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4833
Mailing Address - Country:US
Mailing Address - Phone:757-775-2716
Mailing Address - Fax:
Practice Address - Street 1:4764 FULTON ST E STE 204
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9086
Practice Address - Country:US
Practice Address - Phone:616-541-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health