Provider Demographics
NPI:1669240156
Name:BLUEBIRD COUNSELING AND PSYCHOTHERAPY
Entity type:Organization
Organization Name:BLUEBIRD COUNSELING AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND REGISTRAR AGENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOALLEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:779-537-2243
Mailing Address - Street 1:5026 WHITTIER LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5410
Mailing Address - Country:US
Mailing Address - Phone:779-537-2243
Mailing Address - Fax:
Practice Address - Street 1:5026 WHITTIER LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5410
Practice Address - Country:US
Practice Address - Phone:779-537-2243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)