Provider Demographics
NPI:1922783687
Name:BIRDNOW, MAXWELL (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:
Last Name:BIRDNOW
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 TYPHOON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3399
Mailing Address - Country:US
Mailing Address - Phone:314-494-0484
Mailing Address - Fax:
Practice Address - Street 1:1519 TYPHOON CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3399
Practice Address - Country:US
Practice Address - Phone:314-494-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023020895103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist