Provider Demographics
NPI:1548957673
Name:BEIGE BLACKBIRD LLC
Entity type:Organization
Organization Name:BEIGE BLACKBIRD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MICAIAH
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:513-207-2777
Mailing Address - Street 1:2521 HACKBERRY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2143
Mailing Address - Country:US
Mailing Address - Phone:513-207-2777
Mailing Address - Fax:
Practice Address - Street 1:2521 HACKBERRY ST APT 6
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-2143
Practice Address - Country:US
Practice Address - Phone:513-207-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty