Provider Demographics
NPI:1245949478
Name:BLUE SPRUCE COUNSELING SERVICES
Entity type:Organization
Organization Name:BLUE SPRUCE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CDC I
Authorized Official - Phone:907-434-1079
Mailing Address - Street 1:PO BOX 870758
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0758
Mailing Address - Country:US
Mailing Address - Phone:907-434-1079
Mailing Address - Fax:
Practice Address - Street 1:247 S ALASKA ST STE A
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6335
Practice Address - Country:US
Practice Address - Phone:907-434-1079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health