Provider Demographics
NPI:1831777531
Name:KIRBY, SUSAN MICHELLE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELLE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MICHELLE
Other - Last Name:INCHAUSTEGUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64117-1731
Mailing Address - Country:US
Mailing Address - Phone:913-579-0155
Mailing Address - Fax:
Practice Address - Street 1:8350 N SAINT CLAIR AVE STE 275
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-5114
Practice Address - Country:US
Practice Address - Phone:913-257-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020009376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health