Provider Demographics
NPI:1548816010
Name:BLACKBIRD PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:BLACKBIRD PSYCHOLOGICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:765-393-1008
Mailing Address - Street 1:1901 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2265
Mailing Address - Country:US
Mailing Address - Phone:765-393-1008
Mailing Address - Fax:
Practice Address - Street 1:1901 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2265
Practice Address - Country:US
Practice Address - Phone:765-393-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty