Provider Demographics
NPI:1477126340
Name:KIRBY, SHYANNA (LCSW)
Entity type:Individual
Prefix:
First Name:SHYANNA
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHYANNA
Other - Middle Name:
Other - Last Name:VANMETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1400 EBERHART AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1013
Mailing Address - Country:US
Mailing Address - Phone:217-871-1089
Mailing Address - Fax:
Practice Address - Street 1:1400 EBERHART AVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1013
Practice Address - Country:US
Practice Address - Phone:217-871-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0266481041C0700X
IL150105411104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor