Healthcare Provider Details

I. General information

NPI: 1194340679
Provider Name (Legal Business Name): LITTLE BIRD PSYCHOTHERAPY, P.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W 1ST AVE STE 202
SPOKANE WA
99201-4148
US

IV. Provider business mailing address

1325 W 1ST AVE STE 202
SPOKANE WA
99201-4148
US

V. Phone/Fax

Practice location:
  • Phone: 509-844-2982
  • Fax: 833-520-4835
Mailing address:
  • Phone: 509-844-2982
  • Fax: 833-520-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY CANNON-KEISER
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMHC
Phone: 509-844-2982