MEDICARE: LITTLE BIRD THERAPY, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1982319018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE BIRD THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 144
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66505-0144
Country	:	US
Telephone Number	:	785-553-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 POYNTZ AVE STE 272
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-8039
Country	:	US
Telephone Number	:	785-553-9110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE BEIGHLE
Credential	:	LSCSW
Telephone Number	:	785-553-9110

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	08/23/2023

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