Provider Demographics
NPI:1295439016
Name:BLUE HERON COUNSELING LLC
Entity type:Organization
Organization Name:BLUE HERON COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATANAGARA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-797-3292
Mailing Address - Street 1:928 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1641
Mailing Address - Country:US
Mailing Address - Phone:404-797-3292
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW STE 510
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2462
Practice Address - Country:US
Practice Address - Phone:404-797-3292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health