Provider Demographics
NPI:1750915716
Name:KIRK, BEVERLY DIANE (LPC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANE
Last Name:KIRK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 EQUESTIAN LOOP S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:971-720-3297
Mailing Address - Fax:
Practice Address - Street 1:410 NE 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4624
Practice Address - Country:US
Practice Address - Phone:503-435-4840
Practice Address - Fax:503-200-1416
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional