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General NPI Number Information
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NPI Number | 1679454243
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Entity Type | Organization
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Legal Business Name | BIRDSONG WELLNESS CENTER
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 631 FLORAL LN
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8338
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Country | US
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Telephone | 989-737-0241
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Fax |
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Provider Business Mailing Address
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Address Line | 631 FLORAL LN
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8338
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Country | US
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Telephone | 989-737-0241
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MELISSA KAEKEL
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Credential | LPC, LMHW
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Telephone | 989-737-0241
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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 | 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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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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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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