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General NPI Number Information
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NPI Number | 1780556126
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Entity Type | Organization
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Legal Business Name | BLUE RIVER LEARNING CENTER, LLC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 3920 PLANK RD STE 210
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-7104
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Country | US
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Telephone | 540-470-1405
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 PLANK RD STE 210
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-7104
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Country | US
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Telephone | 540-470-1405
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY JAMES DONALD
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Credential | LBA
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Telephone | 540-470-1405
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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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 | 103TF0000X
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Taxonomy Name | Family Psychologist
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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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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