Individual
MR. BRENT LOGAN KIRBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
17345 N 150 E, SUMMITVILLE, IN 46070-9121
(907) 690-1701
Mailing address
PO BOX 305, SUMMITVILLE, IN 46070-0305
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Enumeration date
08/19/2021
Last updated
08/19/2021
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