MEDICARE: BLUEBIRD COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1215704820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBIRD COUNSELING, LLC

Provider Business Mailing Address
First Line	:	475 CLEVELAND AVE N STE 205
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 CLEVELAND AVE N STE 205
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5053
Country	:	US
Telephone Number	:	218-370-7978
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERTA SORENSON
Credential	:
Telephone Number	:	218-370-7978

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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