Provider Demographics
NPI:1437373461
Name:BIRD, DAVID PAUL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:BIRD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W EXCHANGE ST STE 204E
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2834
Mailing Address - Country:US
Mailing Address - Phone:989-723-5678
Mailing Address - Fax:989-723-5678
Practice Address - Street 1:120 W EXCHANGE ST STE 204E
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2834
Practice Address - Country:US
Practice Address - Phone:989-723-5678
Practice Address - Fax:989-723-5678
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010201831041C0700X
MI4101005388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437373461OtherNPI
MI6801020183OtherLICENSE
MI6801020183OtherLMSW LICENSE