Provider Demographics
NPI:1578779989
Name:BIRD, DAVID NELSON (MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NELSON
Last Name:BIRD
Suffix:
Gender:M
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6413
Mailing Address - Country:US
Mailing Address - Phone:541-758-4501
Mailing Address - Fax:
Practice Address - Street 1:644 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6413
Practice Address - Country:US
Practice Address - Phone:541-758-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist