Provider Demographics
NPI:1003578329
Name:BLACKBIRD BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:BLACKBIRD BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAAF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-304-6748
Mailing Address - Street 1:620 CLEARBROOK ST
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3076
Mailing Address - Country:US
Mailing Address - Phone:817-304-6748
Mailing Address - Fax:
Practice Address - Street 1:620 CLEARBROOK ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3076
Practice Address - Country:US
Practice Address - Phone:817-304-6748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty