Provider Demographics
NPI:1477082410
Name:BIRD, LYDIA ANNA (LPC, MAC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANNA
Last Name:BIRD
Suffix:
Gender:F
Credentials:LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 W KATMAI AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7315
Mailing Address - Country:US
Mailing Address - Phone:907-953-9614
Mailing Address - Fax:
Practice Address - Street 1:379 W KATMAI AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7315
Practice Address - Country:US
Practice Address - Phone:907-953-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109622101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK109622OtherLICENSED PROFESSIONAL COUNSELOR