Provider Demographics
NPI:1750410882
Name:KIRKHAM, GREG P (LCSW)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:P
Last Name:KIRKHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 PORTWAY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-9293
Mailing Address - Country:US
Mailing Address - Phone:615-636-1149
Mailing Address - Fax:
Practice Address - Street 1:1978 PORTWAY RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-9293
Practice Address - Country:US
Practice Address - Phone:615-636-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6155OtherSTATE OF TN