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General NPI Number Information
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NPI Number | 1750523445
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Entity Type | Organization
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Legal Business Name | BLACKBIRD FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 3956 EDGEMOOR PL
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City | OAKLAND
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State | CA
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Zip | 94605-2606
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Country | US
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Telephone | 510-594-4332
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Fax | 510-878-7369
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Provider Business Mailing Address
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Address Line | 3956 EDGEMOOR PL
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City | OAKLAND
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State | CA
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Zip | 94605-2606
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Country | US
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Telephone | 510-594-4332
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Fax | 510-878-7369
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Authorized Official
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Title or Position | CEO
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Name | MATTHEW LINDGREN
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Credential | MFT
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Telephone | 415-828-9829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC46949
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License Number State | CA
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