Provider Demographics
NPI:1649549205
Name:IRBY, KYONNA CHARISSA (LMSW)
Entity type:Individual
Prefix:
First Name:KYONNA
Middle Name:CHARISSA
Last Name:IRBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 BELLMEADE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3505
Mailing Address - Country:US
Mailing Address - Phone:972-217-0519
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON AVE
Practice Address - Street 2:STE 207
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3938
Practice Address - Country:US
Practice Address - Phone:972-442-5300
Practice Address - Fax:214-550-8810
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40687101Y00000X, 104100000X
251B00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency