Blue Heron Counseling LLC
Organization Active NPI Clinical Social Worker · Ingram, TX
NPI 1790491868 · NPPES record last updated May 24, 2024
Key facts
- NPI
- 1790491868
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- BLUE HERON COUNSELING LLC
- Practice address
- 113 Scenic Ridge Rd
Ingram, TX 78025-5549 - Phone
- (830) 715-5483
- Fax
- (830) 217-2348
- NPI assigned
- Jan 23, 2023
- Organization subpart
- No
Authorized official
- Name
- Robyn Sybil Adkins
- Title
- Authorized Official
- Phone
- (512) 970-0176
Practitioners 4
-
Robyn Sybil Adkins, LCSW
-
Melissa Forsness, LCSW
-
Sarah Salinas, LCSW
-
Rachel Wood, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230622001002 | TX | Part B Supplier - Clinic/Group Practice | 4284092396 |
Receives reassigned benefits from 4 practitioners Practice locations: Ingram, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | Yes |
Addresses
Primary practice location
113 Scenic Ridge Rd
Ingram, TX 78025-5549
Mailing address
113 Scenic Ridge Rd
Ingram, TX 78025-5549
Phone (830) 715-5483
Other names
- Blue Heron Counseling
Other providers in Ingram, TX
All providers in Ingram, TX · Clinical Social Worker in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.