Healthcare Provider Details

I. General information

NPI: 1578779989
Provider Name (Legal Business Name): DAVID NELSON BIRD M.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 NW 4TH ST
CORVALLIS OR
97330-6413
US

IV. Provider business mailing address

644 NW 4TH ST
CORVALLIS OR
97330-6413
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-4501
  • Fax:
Mailing address:
  • Phone: 541-758-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0375
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: