Individual
BEVERLY DIANE KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
410 NE 3RD ST STE 2, MCMINNVILLE, OR 97128-4624
(503) 435-4840
(503) 200-1416
Mailing address
2557 EQUESTIAN LOOP S, SALEM, OR 97302
(971) 720-3297
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C5240
OR
Other
Enumeration date
02/28/2020
Last updated
02/28/2020
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