Provider Demographics
NPI:1639949951
Name:BLUE RIVER COUNSELING & WELLNESS, LLC
Entity type:Organization
Organization Name:BLUE RIVER COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LICENSED MENTAL HEALTH COUN
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:317-207-1830
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-0926
Mailing Address - Country:US
Mailing Address - Phone:317-207-1830
Mailing Address - Fax:
Practice Address - Street 1:2177 INTELLIPLEX DR STE 221
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8583
Practice Address - Country:US
Practice Address - Phone:317-207-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty