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Individual

CODY JAMES KIRK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
13911 RIDGEDALE DR STE 490, MINNETONKA, MN 55305-1772
(612) 293-5823
Mailing address
77 COMMERCIAL ST APT 531, BROOKLYN, NY 11222-8043
(952) 356-6515

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
05350
MN
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
09/04/2023
Last updated
05/27/2026
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