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BLUE HERON NEUROFEEDBACK AND COUNSELING NPI 1669039178


NPI Information

NPI: 1669039178
Provider Name: BLUE HERON NEUROFEEDBACK AND COUNSELING
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
3277 WHITE MOUNTAIN HWY
NORTH CONWAY, NH
ZIP 03860
Phone: (603) 356-6400
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BLUE HERON NEUROFEEDBACK AND COUNSELING is a multi-specialty clinic center in North Conway, NH. BLUE HERON NEUROFEEDBACK AND COUNSELING NPI is 1669039178. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3277 WHITE MOUNTAIN HWY
NORTH CONWAY, NH
ZIP 03860-113
Phone: (603) 356-6400

The provider's authorized official is Stacie L Leclerc .
The authorized official title is Owner and has the following contact phone number (603) 356-6400.

The enumeration date for this NPI number is 5/21/2019 and was last updated on 8/1/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)No
2103T00000XPsychologistNo
3103TA0400XPsychologistAddiction (Substance Use Disorder)No
4106H00000XMarriage & Family TherapistNo
5261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
6261QM1300XClinic/CenterMulti-SpecialtyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13118551MEDICAIDNEW HAMPSHIRE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.