| Bluebird Psychotherapy, Pllc | |
|
725 W Alder St Suite 28 Missoula MT 59802-4036 | |
| (406) 546-0082 | |
| Not Available |
| Full Name | Bluebird Psychotherapy, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 725 W Alder St, Missoula, Montana |
| Authorized Official Name and Position | Ivy Vanessa Irvine (OWNER) |
| Authorized Official Contact | 4065460082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluebird Psychotherapy, Pllc Po Box 1384 Lolo MT 59847-1384 Ph: (406) 546-0082 | Bluebird Psychotherapy, Pllc 725 W Alder St Suite 28 Missoula MT 59802-4036 Ph: (406) 546-0082 |
| NPI Number | 1760848824 |
|---|---|
| Provider Enumeration Date | 01/05/2016 |
| Last Update Date | 01/05/2016 |
| Medicare PECOS PAC ID | 8325473168 |
|---|---|
| Medicare Enrollment ID | O20200124000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760848824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 924 (Montana) | Primary |
| Provider Name | Ivy Vanessa Irvine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467768705 PECOS PAC ID: 1052746898 Enrollment ID: I20200124002143 |
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