Healthcare Provider Details

I. General information

NPI: 1215910377
Provider Name (Legal Business Name): BLUE RIVER COUNSELING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S TOMPKINS ST
SHELBYVILLE IN
46176-1205
US

IV. Provider business mailing address

15 S TOMPKINS ST P O BOX 1042
SHELBYVILLE IN
46176-1205
US

V. Phone/Fax

Practice location:
  • Phone: 317-392-0171
  • Fax: 317-392-0171
Mailing address:
  • Phone: 317-392-0171
  • Fax: 317-392-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001457A
License Number StateIN

VIII. Authorized Official

Name: MS. DEBORAH LEE GRIFFEY
Title or Position: PRESIDENT
Credential: MSW, LCSW
Phone: 317-392-0171