Provider Demographics
NPI:1104224674
Name:KIRK, JERHONDA
Entity type:Individual
Prefix:
First Name:JERHONDA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 MOLLY MEADOWS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3911
Mailing Address - Country:US
Mailing Address - Phone:256-323-5596
Mailing Address - Fax:
Practice Address - Street 1:4045 SPENCER ST
Practice Address - Street 2:A45
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-9304
Practice Address - Country:US
Practice Address - Phone:702-637-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor