Provider Demographics
NPI:1417531781
Name:BLUE HOUSE THERAPY, LLC
Entity Type:Organization
Organization Name:BLUE HOUSE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC, LMHC
Authorized Official - Phone:314-600-6606
Mailing Address - Street 1:42 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1226
Mailing Address - Country:US
Mailing Address - Phone:314-600-6606
Mailing Address - Fax:
Practice Address - Street 1:42 STOCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1226
Practice Address - Country:US
Practice Address - Phone:413-600-8066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health