MEDICARE: ASHLEA CORINNE BIRD

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	:	1518502137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEA CORINNE BIRD

Provider Business Mailing Address
First Line	:	7577 CHASEWOOD LOOP
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5600
Country	:	US
Telephone Number	:	912-424-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 AUSTIN BLUFFS PKWY STE C
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80918-5758
Country	:	US
Telephone Number	:	720-485-3826
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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