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General NPI Number Information
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NPI Number | 1932831625
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Entity Type | Organization
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Legal Business Name | BLUE BIRD NEST LLC
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 28910 LEROY COWART RD
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City | HOLDEN
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State | LA
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Zip | 70744-5432
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Country | US
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Telephone | 985-320-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 28910 LEROY COWART RD
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City | HOLDEN
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State | LA
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Zip | 70744-5432
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Country | US
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Telephone | 985-320-0655
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MELANIE NEAL
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Credential |
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Telephone | 985-320-0655
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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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