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General NPI Number Information
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NPI Number | 1326851098
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Entity Type | Organization
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Legal Business Name | BLUE BIRD DAY PNW LLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 820 N. WILLIAM ST.
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City | POST FALLS
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State | ID
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Zip | 83854-8657
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Country | US
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Telephone | 208-818-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 820 N. WILLIAM ST.
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City | POST FALLS
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State | ID
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Zip | 83854-8657
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Country | US
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Telephone | 208-818-5016
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Fax |
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Authorized Official
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Title or Position | CLINICAL ADMINISTRATION
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Name | JENNIFER MAYBERRY
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Credential | LMSW
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Telephone | 208-659-2049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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