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General NPI Number Information
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NPI Number | 1083385306
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Entity Type | Organization
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Legal Business Name | BLUEBIRD BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 2815 100TH ST
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City | URBANDALE
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State | IA
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Zip | 50322-3860
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Country | US
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Telephone | 515-344-7755
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Fax | 515-809-3855
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Provider Business Mailing Address
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Address Line | 16174 150TH ST
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City | PERRY
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State | IA
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Zip | 50220-6211
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Country | US
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Telephone | 515-344-7755
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Fax | 515-809-3855
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Authorized Official
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Title or Position | ARNP, PMHNP-BC/OWNER
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Name | MEGAN L STUKENHOLTZ
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Credential | ARNP, PMHNP-BC
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Telephone | 515-344-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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