Provider Demographics
NPI:1083385306
Name:BLUEBIRD BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BLUEBIRD BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP, PMHNP-BC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUKENHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, PMHNP-BC
Authorized Official - Phone:515-344-7755
Mailing Address - Street 1:16174 150TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:IA
Mailing Address - Zip Code:50220-6211
Mailing Address - Country:US
Mailing Address - Phone:515-344-7755
Mailing Address - Fax:515-809-3855
Practice Address - Street 1:2815 100TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3860
Practice Address - Country:US
Practice Address - Phone:515-344-7755
Practice Address - Fax:515-809-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5202608OtherIOWA BOARD OF PHARMACY - CSA
IAG118802OtherIOWA BOARD OF NURSING
IAG118802OtherIOWA BOARD OF NURSING