Provider Demographics
NPI:1457026874
Name:BIRDHAUS INDIVIDAUL & MARRIAGE COUNSELING, INC.
Entity Type:Organization
Organization Name:BIRDHAUS INDIVIDAUL & MARRIAGE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-674-3499
Mailing Address - Street 1:13400 RIVERSIDE DR STE 318
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2501
Mailing Address - Country:US
Mailing Address - Phone:323-505-2473
Mailing Address - Fax:
Practice Address - Street 1:13400 RIVERSIDE DR STE 318
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2501
Practice Address - Country:US
Practice Address - Phone:323-505-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty