Provider Demographics
NPI:1558606210
Name:BIRD BEHAVIORAL SERVICES INC.
Entity Type:Organization
Organization Name:BIRD BEHAVIORAL SERVICES INC.
Other - Org Name:EXPANDING HORIZONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:321-805-4426
Mailing Address - Street 1:816 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-3371
Mailing Address - Country:US
Mailing Address - Phone:321-805-4426
Mailing Address - Fax:407-902-0019
Practice Address - Street 1:816 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3371
Practice Address - Country:US
Practice Address - Phone:321-805-4426
Practice Address - Fax:407-902-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5536101YM0800X
FL1-05-2139103K00000X
FL251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010950100Medicaid
FL010369800Medicaid