| Blue Heron Neurofeedback And Counseling | |
|
3277 White Mountain Hwy North Conway NH 03860-5113 | |
| (603) 356-6400 | |
| Not Available |
| Full Name | Blue Heron Neurofeedback And Counseling |
|---|---|
| Speciality | Clinic/Center |
| Location | 3277 White Mountain Hwy, North Conway, New Hampshire |
| Authorized Official Name and Position | Stacie L Leclerc (OWNER) |
| Authorized Official Contact | 6033566400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Heron Neurofeedback And Counseling 286 Town Hall Rd Intervale NH 03845-6108 Ph: (603) 356-6400 | Blue Heron Neurofeedback And Counseling 3277 White Mountain Hwy North Conway NH 03860-5113 Ph: (603) 356-6400 |
| NPI Number | 1669039178 |
|---|---|
| Provider Enumeration Date | 05/21/2019 |
| Last Update Date | 08/01/2022 |
| Certification Date | 08/01/2022 |
| Medicare PECOS PAC ID | 5294262044 |
|---|---|
| Medicare Enrollment ID | O20241218002466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669039178 | NPI | - | NPPES |
| 3118551 | Medicaid | NH |
| Provider Name | Lydia Anne Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386129856 PECOS PAC ID: 2365796703 Enrollment ID: I20181121000553 |
| Provider Name | Stacie L Leclerc |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467636167 PECOS PAC ID: 6103353958 Enrollment ID: I20250103000104 |
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