MEDICARE: BLUEBIRD COUNSELING AND WELLNESS, 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	:	1366024184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBIRD COUNSELING AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	196 W RIVER RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9573
Country	:	US
Telephone Number	:	315-281-5870
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 W RIVER RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9573
Country	:	US
Telephone Number	:	315-281-5870
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. TIFFANY M PEERY
Credential	:	LPCC-S
Telephone Number	:	315-281-5870

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	05/11/2021

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