Provider Demographics
NPI:1457520546
Name:KIRK, ALTON R (PHD, CLINICAL PSYC)
Entity Type:Individual
Prefix:DR
First Name:ALTON
Middle Name:R
Last Name:KIRK
Suffix:
Gender:M
Credentials:PHD, CLINICAL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 E LANSING DR
Mailing Address - Street 2:SUITE 224
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7785
Mailing Address - Country:US
Mailing Address - Phone:517-351-9006
Mailing Address - Fax:517-351-6105
Practice Address - Street 1:1451 E LANSING DR
Practice Address - Street 2:SUITE 224
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7785
Practice Address - Country:US
Practice Address - Phone:517-351-9006
Practice Address - Fax:517-351-6105
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0005774436OtherMAGELLAN
MI0005774436OtherPROVIDERS HEALTH PLAN
MI0005774431OtherMCCLAREN HEALTH CARE
MI0005774431OtherAETNA