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General NPI Number Information
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NPI Number | 1194878686
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Entity Type | Organization
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Legal Business Name | BLUEBIRD, INC.
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 1332 GUSDORF RD STE B
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City | TAOS
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State | NM
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Zip | 87571-6372
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Country | US
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Telephone | 575-751-4065
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Fax | 575-751-4075
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Provider Business Mailing Address
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Address Line | PO BOX 2518
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-2518
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Country | US
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Telephone | 575-751-4065
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Fax | 575-751-4075
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAMONA M. SILKWOOD
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Credential | LPCC
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Telephone | 575-751-4065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 005681
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License Number State | NM
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