Provider Demographics
NPI:1023280120
Name:JIM KIRK, EDS, MFT
Entity type:Organization
Organization Name:JIM KIRK, EDS, MFT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, EDS
Authorized Official - Phone:775-329-4582
Mailing Address - Street 1:1005 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2706
Mailing Address - Country:US
Mailing Address - Phone:775-329-4582
Mailing Address - Fax:
Practice Address - Street 1:1005 FOREST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-2706
Practice Address - Country:US
Practice Address - Phone:775-329-4582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV937-L101YA0400X
NV556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty