Provider Demographics
NPI:1790491868
Name:BLUE HERON COUNSELING LLC
Entity Type:Organization
Organization Name:BLUE HERON COUNSELING LLC
Other - Org Name:BLUE HERON COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:SYBIL
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-970-0176
Mailing Address - Street 1:113 SCENIC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:INGRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78025-5549
Mailing Address - Country:US
Mailing Address - Phone:830-715-5483
Mailing Address - Fax:830-217-2348
Practice Address - Street 1:113 SCENIC RIDGE RD
Practice Address - Street 2:
Practice Address - City:INGRAM
Practice Address - State:TX
Practice Address - Zip Code:78025-5549
Practice Address - Country:US
Practice Address - Phone:830-715-5483
Practice Address - Fax:830-217-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty