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General NPI Number Information
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NPI Number | 1669342697
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Entity Type | Organization
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Legal Business Name | BLUE RIVER COUNSELING LLC
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 01/10/2026
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Provider Practice Location Address
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Address Line | 1504 N JEFFERSON ST
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City | HUNTINGTON
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State | IN
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Zip | 46750-1401
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Country | US
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Telephone | 260-229-0954
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Fax |
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Provider Business Mailing Address
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Address Line | 207 N LINE ST
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City | COLUMBIA CITY
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State | IN
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Zip | 46725-2013
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Country | US
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Telephone | 260-268-0010
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Fax | 260-268-0600
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. LISA MARIE WOOLEY
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Credential | PSY.D. HSPP
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Telephone | 260-229-0954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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