# BIRD PSYCHOLOGICAL GROUP PLLC

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

## Provider details

- **NPI number:** 1962261404
- **Authorized official:** DR. JASON M BIRD DOCTORATE (PSYCHOLOGIST/CO-OWNER)
- **Authorized official phone:** (864) 905-8195

## Contact information

- **Practice address:** 13950 BALLANTYNE CORPORATE PL STE 155, CHARLOTTE, NC 28277-3163
- **Practice address phone:** (864) 905-8195
- **Mailing address:** 13950 BALLANTYNE CORPORATE PL STE 155, CHARLOTTE, NC 28277-3163
- **Mailing address phone:** (864) 905-8195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/18/2024
- **Last updated:** 02/05/2025