MEDICARE: BLUE IRIS COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578439303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE IRIS COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	1263 MAIN ST STE 122
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-1341
Country	:	US
Telephone Number	:	920-315-8643
Fax Number	:	920-214-1274

Provider Business Practice Location Address
First Line	:	1263 MAIN ST STE 122
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54302-1341
Country	:	US
Telephone Number	:	920-315-8643
Fax Number	:	920-214-1274

Authorized Official
Title or Position	:	OWNER
Name	:	MEGAN MEYERHOFER
Credential	:	LMFT
Telephone Number	:	920-315-8643

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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