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NPI Code Detail

MEDICARE: BLUE HERON COUNSELING AND CONSULTING PLLC

MEDICARE: BLUE HERON COUNSELING AND CONSULTING PLLC
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1154018794
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE HERON COUNSELING AND CONSULTING PLLC
Provider Business Mailing Address
First Line : PO BOX 501
Second Line :
City : ALBEMARLE
State : NC
Zip : 28002-0501
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 124 E NORTH ST
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-4048
Country : US
Telephone Number : 704-802-2629
Fax Number :
Authorized Official
Title or Position : MEMBER/ORGANIZER
Name : SETH UTLEY
Credential : LCMHC
Telephone Number : 704-802-2629
Provider Enumeration Date : 04/24/2023
Last Update Date : 04/24/2023

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