Organization
BLUEBIRD COUNSELING AND PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS MOALLEM LMHC (THERAPIST AND REGISTRAR AGENT)
(779) 537-2243
Entity
Organization
Contact information
Practice address
5026 WHITTIER LN, ROCKFORD, IL 61114-5410
(779) 537-2243
Mailing address
5026 WHITTIER LN, ROCKFORD, IL 61114-5410
(779) 537-2243
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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