Blue Water Healing Clinic LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BLUE WATER HEALING CLINIC LLC

Practice address

1902 4TH St
Jackson, MI 49203-4040

Phone

(734) 273-9681

NPI assigned

May 21, 2025

Last updated

May 21, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amita Aponte

Title

Ceo

Phone

(810) 937-6259

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Donovan Khamoro, LCSW

  • Clinical Social Worker
  • New Hudson, MI
  • NPI 1275205429
  Medicare reassignment
• Lorin Burke

  • Professional Counselor
  • Southgate, MI
  • NPI 1275823304
  NPD (past)
• Sierra Gant, LLMSW

  • Clinical Social Worker
  • Jackson, MI
  • NPI 1396619169
  NPD (past)
• Clint William Irwin, MA LPC

  • Mental Health Counselor
  • Jackson, MI
  • NPI 1396054920

  Professional

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1861284267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 LITTLE ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 4TH ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492034040",
            "telephone_number": "734-273-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER HEALING CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-21",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "APONTE",
        "authorized_official_first_name": "AMITA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "810-937-6259"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonnie Ann Blanton, LMSW
• Morghen Rylee Blevins
• Roger Earl Bloomer, MD
• Kassidy Lynn Blough
• Blue Ridge Counseling PLLC
• Briana Marie Blum, PA-C
• Douglas William Blume, MA LLPC
• Bobchi Inverciones L.L.C. (Tri-State Mobile Ultrasound)
• Nina Marie Bock, PA-C
• Aida Bodour, M.D.

• Professional Counselor in Jackson, MI
• Providers in Jackson, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.