Provider Demographics
NPI:1629814306
Name:BLUE BARN THERAPY GROUP, LLC
Entity type:Organization
Organization Name:BLUE BARN THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:253-335-6013
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-0772
Mailing Address - Country:US
Mailing Address - Phone:253-335-6013
Mailing Address - Fax:
Practice Address - Street 1:38122 307TH AVE SE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-9643
Practice Address - Country:US
Practice Address - Phone:253-335-6013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty