Blue Heron Neurofeedback and Counseling
Organization Active NPI Multi-Specialty Clinic/Center · Conway, NH
NPI 1669039178 · NPPES record last updated Nov 11, 2025
Key facts
- NPI
- 1669039178
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- BLUE HERON NEUROFEEDBACK AND COUNSELING
- Practice address
- 379 White Mountain Hwy
Conway, NH 03818-4206 - Phone
- (603) 356-6400
- Fax
- (603) 413-4666
- NPI assigned
- May 21, 2019
- Organization subpart
- No
Authorized official
- Name
- Stacie L Leclerc, LCMHC, MLADC
- Title
- Owner
- Phone
- (603) 356-6400
Practitioners 5
-
Lydia Anne McKenzie, DNP, PMHNP-BC
-
Joseph Bates, CRSW
-
Judy Ann Baker, FAMILY NURSE PRACTIT
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 30D2330333 | Blue Heron Neurofeedback & Counseling | Certificate of waiver | Sep 14, 2027 |
| 30D2330336 | Blue Heron Neurofeedback & Counseling | Certificate of waiver | Sep 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241218002466 | NH | Part B Supplier - Clinic/Group Practice | 5294262044 |
Receives reassigned benefits from 2 practitioners Practice locations: Littleton, NH; North Conway, NH; North Haverhill, NH; Plymouth, NH; Gorham, NH |
National Provider Directory
Locations
379 White Mountain Hwy
Conway, NH 03818
Phone (603) 356-6400
515 Main St
Gorham, NH 03581
Phone 6033566400 ext. 1
111 Saranac St
Ste 140
Littleton, NH 03561
Phone (603) 356-6400
3277 White Mountain Hwy
North Conway, NH 03860
Phone (603) 356-6400
3277 White Mountain Hwy
Unit 2
North Conway, NH 03860
Phone (603) 356-6400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Psychologist |
103T00000X | |||
| Addiction (Substance Use Disorder) Psychologist |
103TA0400X | |||
| Marriage & Family Therapist |
106H00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X |
Addresses
Primary practice location
379 White Mountain Hwy
Conway, NH 03818-4206
Mailing address
111 Saranac St Ste 140
Littleton, NH 03561-4089
Phone (603) 356-6400
Other practice location 1
111 Saranac St Ste 140
Littleton, NH 03561-4089
Phone (603) 356-6400 ext. 1
Other practice location 2
515 Main St
Gorham, NH 03581-4901
Phone (603) 356-6400 ext. 1
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3138509 | Medicaid | NH | |
| 3147125 | Medicaid | NH | |
| 3118551 | Medicaid | NH | |
| 3149511 | Medicaid | NH | |
| 3148512 | Medicaid | NH | |
| 3138507 | Medicaid | NH | |
| 3138508 | Medicaid | NH | |
| 3147950 | Medicaid | NH |
Other providers in Conway, NH
- Samantha Bellini
- Elizabeth E Bicio
- Cheryl Bildner
- Bio-Medical Applications of New Hampshire, Inc.
- Blossoming Connections LLC
- Suzanne Borsody
- Melanie Bova
- Jennifer Bowser
- Judith A Brewster
- Laurie Brodeur
All providers in Conway, NH · Multi-Specialty Clinic/Center in New Hampshire
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.