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General NPI Number Information
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NPI Number | 1548957673
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Entity Type | Organization
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Legal Business Name | BEIGE BLACKBIRD LLC
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Dates
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Enumeration Date | 04/19/2023
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 2521 HACKBERRY ST APT 6
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City | CINCINNATI
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State | OH
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Zip | 45206-2143
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Country | US
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Telephone | 513-207-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 2521 HACKBERRY ST APT 6
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City | CINCINNATI
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State | OH
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Zip | 45206-2143
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Country | US
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Telephone | 513-207-2777
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Fax |
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Authorized Official
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Title or Position | OWNER AND CLINICIAN
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Name | MS. MICAIAH DANIELLE COPELAND
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Credential | MA
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Telephone | 513-207-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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