Provider Demographics
NPI:1710487269
Name:BLUE CEDAR COUNSELING
Entity Type:Organization
Organization Name:BLUE CEDAR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:478-714-7189
Mailing Address - Street 1:3263 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2343
Mailing Address - Country:US
Mailing Address - Phone:478-714-7189
Mailing Address - Fax:
Practice Address - Street 1:3263 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2343
Practice Address - Country:US
Practice Address - Phone:478-714-7189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty