Organization Name: | BLUE RIVER COUNSELING, LLC |
NPI Number: | 1285019828 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KERRY ANN MAYHALL (CEO/THERAPIST) |
Mailing Address: | 22728 228th Avenue Se Maple Valley |
State: | WA US |
Postal Code: | 98038 |
Phone Number: | 4254291588 |
Fax Number: | |
NPI Enumeration Date: | 07/24/2015 |
NPI Last Update Date: | 07/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH60449477 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |