Provider Demographics
NPI:1316354475
Name:KIRK, MICHAEL EARL (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EARL
Last Name:KIRK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MING AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4619
Mailing Address - Country:US
Mailing Address - Phone:661-833-5890
Mailing Address - Fax:661-833-5892
Practice Address - Street 1:5500 MING AVE STE 120
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4619
Practice Address - Country:US
Practice Address - Phone:661-833-5890
Practice Address - Fax:661-833-5892
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13717103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical