Provider Demographics
NPI:1821471129
Name:BIRDSHIRE, MICAH LYNN (LPC (CO); LPCC (NM))
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:LYNN
Last Name:BIRDSHIRE
Suffix:
Gender:F
Credentials:LPC (CO); LPCC (NM)
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:
Other - Last Name:SHIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4730 BECKNER ROAD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-989-4500
Mailing Address - Fax:505-474-4663
Practice Address - Street 1:4730 BECKNER ROAD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-989-4500
Practice Address - Fax:505-474-4663
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104680101Y00000X
NMCCMH0205691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor