Basic Information
| Provider Information | |||||||||
| NPI: | 1386285476 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BLUEBIRD COUNSELING OF CENTRAL OHIO L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1421 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432161421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147530836 | ||||||||
| FaxNumber: | 6143893841 | ||||||||
| Practice Location | |||||||||
| Address1: | 7243 SAWMILL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430165005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143893814 | ||||||||
| FaxNumber: | 6143893841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2019 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | ELISE | ||||||||
| AuthorizedOfficialTitleorPosition: | COMPANY MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6143893814 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | L.P.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.