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General NPI Number Information
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NPI Number | 1457026874
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Entity Type | Organization
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Legal Business Name | BIRDHAUS INDIVIDAUL & MARRIAGE COUNSELING, INC.
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 13400 RIVERSIDE DR STE 318
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2501
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Country | US
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Telephone | 323-505-2473
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Fax |
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Provider Business Mailing Address
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Address Line | 13400 RIVERSIDE DR STE 318
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2501
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Country | US
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Telephone | 323-505-2473
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MEGHAN ROE
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Credential |
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Telephone | 617-674-3499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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