Provider Demographics
NPI:1649338443
Name:KIRLEY, KEVIN P (MS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:KIRLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 165TH STREET W.
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044
Mailing Address - Country:US
Mailing Address - Phone:952-435-0022
Mailing Address - Fax:
Practice Address - Street 1:10535 165TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5729
Practice Address - Country:US
Practice Address - Phone:952-435-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1249103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10N14KIOtherBLUE CROSS BLUE SHIELD
MN138154OtherU CARE
MN62-50536OtherMEDICA-UBH
MN30433-01OtherPREFERRED ONE
MNHP50743OtherHEALTH PARTNERS