Provider Demographics
NPI:1992110910
Name:BIRCHWOOD THERAPY SERVICES, PLC
Entity type:Organization
Organization Name:BIRCHWOOD THERAPY SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BAD HEART BULL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:320-291-6137
Mailing Address - Street 1:13968 CYPRESS DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-5904
Mailing Address - Country:US
Mailing Address - Phone:218-454-1082
Mailing Address - Fax:218-454-1083
Practice Address - Street 1:13968 CYPRESS DR STE 1A
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-5904
Practice Address - Country:US
Practice Address - Phone:218-454-1082
Practice Address - Fax:218-454-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4453103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty