| Blackbird Counseling, Llc | |
|
4646 W Jefferson Blvd Ste 250 Fort Wayne IN 46804-6832 | |
| (260) 627-9158 | |
| Not Available |
| Full Name | Blackbird Counseling, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4646 W Jefferson Blvd Ste 250, Fort Wayne, Indiana |
| Authorized Official Name and Position | Victoria Prokop (THERAPIST/OWNER) |
| Authorized Official Contact | 2606279158 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackbird Counseling, Llc 4646 W Jefferson Blvd Ste 250 Fort Wayne IN 46804-6832 Ph: (260) 627-9158 | Blackbird Counseling, Llc 4646 W Jefferson Blvd Ste 250 Fort Wayne IN 46804-6832 Ph: (260) 627-9158 |
| NPI Number | 1356803936 |
|---|---|
| Provider Enumeration Date | 04/03/2019 |
| Last Update Date | 10/13/2022 |
| Certification Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356803936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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