| Free Bird Counseling And Consultation | |
|
1684 Selby Ave Saint Paul MN 55104-6149 | |
| (651) 206-8955 | |
| (651) 389-9397 |
| Full Name | Free Bird Counseling And Consultation |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1684 Selby Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Susan J Bollinger Brown (EXECUTIVE PARTNER) |
| Authorized Official Contact | 6512068955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Free Bird Counseling And Consultation 1684 Selby Avenue St Paul MN 55104-6149 Ph: (651) 206-8955 | Free Bird Counseling And Consultation 1684 Selby Ave Saint Paul MN 55104-6149 Ph: (651) 206-8955 |
| NPI Number | 1194127456 |
|---|---|
| Provider Enumeration Date | 09/18/2014 |
| Last Update Date | 12/04/2018 |
| Medicare PECOS PAC ID | 3870839087 |
|---|---|
| Medicare Enrollment ID | O20190109001391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194127456 | NPI | - | NPPES |
| 1265500755 | Other | MN | INDIVIDUAL NPI |
| 165172200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | 13061 (Minnesota) | Primary |
| Provider Name | Susan J Bollinger Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265500755 PECOS PAC ID: 2769728989 Enrollment ID: I20190109001576 |
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