Provider Demographics
NPI:1194878686
Name:BLUEBIRD, INC.
Entity type:Organization
Organization Name:BLUEBIRD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-751-4065
Mailing Address - Street 1:PO BOX 2518
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-2518
Mailing Address - Country:US
Mailing Address - Phone:575-751-4065
Mailing Address - Fax:575-751-4075
Practice Address - Street 1:1332 GUSDORF RD STE B
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6372
Practice Address - Country:US
Practice Address - Phone:575-751-4065
Practice Address - Fax:575-751-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty