MEDICARE: BLUE WATER COUNSELING AND WELLNESS CENTER, INC.

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	251S00000X	Community/Behavioral Health Agency	6401010236	MI

General Provider Information

NPI Number	:	1023560851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE WATER COUNSELING AND WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	18600 FLORENCE ST STE T6G
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6600
Country	:	US
Telephone Number	:	586-246-7837
Fax Number	:	586-779-8146

Provider Business Practice Location Address
First Line	:	18600 FLORENCE ST STE T6G
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6600
Country	:	US
Telephone Number	:	586-246-7837
Fax Number	:	586-779-8146

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY L GOODWIN
Credential	:	BSN, MRC, LPC
Telephone Number	:	586-246-7837

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	01/06/2026

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