Provider Demographics
NPI:1992013023
Name:BIRD, ELIMA (CDP)
Entity Type:Individual
Prefix:MS
First Name:ELIMA
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:WELLPINIT
Mailing Address - State:WA
Mailing Address - Zip Code:99040-0540
Mailing Address - Country:US
Mailing Address - Phone:509-258-7502
Mailing Address - Fax:509-258-4880
Practice Address - Street 1:6228 E. OLD SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:WELLPINIT
Practice Address - State:WA
Practice Address - Zip Code:99040-0540
Practice Address - Country:US
Practice Address - Phone:509-258-7502
Practice Address - Fax:509-258-4880
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60698838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)