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General NPI Number Information
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NPI Number | 1417482274
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Entity Type | Organization
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Legal Business Name | BLUE OCEAN COUNSELING & COACHING, LLC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 3030 W MARQUETTE ST
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City | PEORIA
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State | IL
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Zip | 61605-1211
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Country | US
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Telephone | 309-573-5818
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Fax |
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Provider Business Mailing Address
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Address Line | 4507 W CLAREDDA CT
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City | PEORIA
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State | IL
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Zip | 61615-2720
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Country | US
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Telephone | 309-573-5818
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/OWNER/EXEC. DIR.
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Name | MRS. ALYSSA LATONIA RODGERS
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Credential | M.S., M.A., NCC, LPC
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Telephone | 309-573-5818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178012997
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License Number State | IL
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