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General NPI Number Information
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NPI Number | 1215704820
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Entity Type | Organization
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Legal Business Name | BLUEBIRD COUNSELING, LLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 475 CLEVELAND AVE N STE 205
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City | SAINT PAUL
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State | MN
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Zip | 55104-5053
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Country | US
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Telephone | 218-370-7978
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Fax |
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Provider Business Mailing Address
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Address Line | 475 CLEVELAND AVE N STE 205
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City | SAINT PAUL
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State | MN
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Zip | 55104-5053
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTA SORENSON
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Credential |
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Telephone | 218-370-7978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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