Healthcare Provider Details

I. General information

NPI: 1386285476
Provider Name (Legal Business Name): BLUEBIRD COUNSELING OF CENTRAL OHIO L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 SAWMILL RD STE 105
DUBLIN OH
43016-5005
US

IV. Provider business mailing address

PO BOX 1421
COLUMBUS OH
43216-1421
US

V. Phone/Fax

Practice location:
  • Phone: 614-389-3814
  • Fax: 614-389-3841
Mailing address:
  • Phone: 614-753-0836
  • Fax: 614-389-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ELISE DAVIS
Title or Position: COMPANY MANAGER
Credential: L.P.C.
Phone: 614-389-3814