Provider Demographics
NPI:1972996718
Name:BIRD, NICOLE JUNE (T-LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JUNE
Last Name:BIRD
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2129
Mailing Address - Country:US
Mailing Address - Phone:913-890-7576
Mailing Address - Fax:
Practice Address - Street 1:1211 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2129
Practice Address - Country:US
Practice Address - Phone:913-890-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2659106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist