BLACKBIRD COUNSELING, LLC (NPI# 1356803936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356803936 |
| Entity Type | Organization |
| Organization Name | BLACKBIRD COUNSELING, LLC |
| Practice Address |
4656 W Jefferson Blvd Ste 210 Fort Wayne IN 46804-6884 |
| Mailing Address |
429 E Dupont Rd # 122 Fort Wayne IN 46825-2051 |
| Practice Telephone | 2606279158 |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2019-04-03 |
| Authorized Official Name | MRS. VICTORIA PROKOP (THERAPIST/OWNER) |
| Authorized Official Telephone | 2606279158 |
| Authorized Official Credential | LMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Blackbird Counseling, LLC | 1640 Logan Street, Denver, CO 80203 |
| Street Address |
4656 W JEFFERSON BLVD STE 210 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-6884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447718325 | Victoria Lynn Prokop | Counselor | 4656 W Jefferson Blvd Ste 210, Fort Wayne, IN 46804-6884 | 2019-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548881899 | Emily H Cook | Counselor | 2130 Pemberton Dr, Fort Wayne, IN 46805-4628 | 2020-04-28 |
| 1871113274 | At Your Pace Counseling, LLC | Counselor | 6717 Sky Blue Dr, Fort Wayne, IN 46804-4648 | 2020-04-26 |
| 1962049809 | Lynne Beardsley | Counselor | 4630 W Jefferson Blvd Ste 11, Fort Wayne, IN 46804-6856 | 2019-12-10 |
| 1578108767 | Wholistic Wellness Counseling and Consulting LLC | Counselor | 1129 Rivermet Ave, Fort Wayne, IN 46805-4232 | 2019-11-11 |
| 1922654722 | Nicole Conrad | Counselor | 908 Manck Dr, Fort Wayne, IN 46814-8995 | 2019-08-16 |
| 1336794148 | Healing Through Art | Counselor | 3521 Lake Ave # B1, Fort Wayne, IN 46805-5536 | 2019-08-08 |
| 1013578749 | A.w. Holdings, LLC | Counselor | 3900 Hursh Rd, Fort Wayne, IN 46845-9677 | 2019-06-24 |
| 1811450646 | Living Waters Peace Center | Counselor | 3262 Mallard Cove Ln Ste B, Fort Wayne, IN 46804-2883 | 2019-04-09 |
| 1447718325 | Victoria Lynn Prokop | Counselor | 4656 W Jefferson Blvd Ste 210, Fort Wayne, IN 46804-6884 | 2019-03-09 |
| 1811467632 | Believe Counseling and Consulting | Counselor | 2200 Lake Ave Ste 140, Fort Wayne, IN 46805-5351 | 2018-12-05 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on BLACKBIRD COUNSELING, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.