# FIREBIRD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912281486
- **Authorized official:** MS. PHUNG HORTON JEFFERSON (MANAGING MEMBER)
- **Authorized official phone:** (702) 401-3632

## Contact information

- **Practice address:** 601 S 10TH ST, LAS VEGAS, NV 89101-7027
- **Practice address phone:** (702) 401-3632
- **Practice address fax:** (702) 382-4071
- **Mailing address:** PO BOX 12924, LAS VEGAS, NV 89112-0924
- **Mailing address phone:** (702) 401-3632
- **Mailing address fax:** (702) 382-4071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |

## Other

- **Enumeration date:** 10/03/2011
- **Last updated:** 04/20/2016