Provider Demographics
NPI:1659068724
Name:BLUE CARDINAL COUNSELING PLLC
Entity Type:Organization
Organization Name:BLUE CARDINAL COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BEHAVIORAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEEGAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-996-3639
Mailing Address - Street 1:235 HIGH ST STE 509510
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5429
Mailing Address - Country:US
Mailing Address - Phone:304-602-7332
Mailing Address - Fax:
Practice Address - Street 1:235 HIGH ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5429
Practice Address - Country:US
Practice Address - Phone:304-996-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty