Provider Demographics
NPI:1124787957
Name:MATTHEW KIRBY
Entity type:Organization
Organization Name:MATTHEW KIRBY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:828-506-9979
Mailing Address - Street 1:1129 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-2601
Mailing Address - Country:US
Mailing Address - Phone:828-506-9799
Mailing Address - Fax:828-787-8183
Practice Address - Street 1:1129 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2601
Practice Address - Country:US
Practice Address - Phone:828-506-9799
Practice Address - Fax:828-787-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty