| Blue Heron Neurofeedback And Counseling | |
|
379 White Mountain Hwy Conway NH 03818-4206 | |
| (603) 356-6400 | |
| (603) 413-4666 |
| Full Name | Blue Heron Neurofeedback And Counseling |
|---|---|
| Speciality | Clinic/Center |
| Location | 379 White Mountain Hwy, 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 111 Saranac St Ste 140 Littleton NH 03561-4089 Ph: (603) 356-6400 | Blue Heron Neurofeedback And Counseling 379 White Mountain Hwy Conway NH 03818-4206 Ph: (603) 356-6400 |
| NPI Number | 1669039178 |
|---|---|
| Provider Enumeration Date | 05/21/2019 |
| Last Update Date | 11/11/2025 |
| Certification Date | 11/11/2025 |
| Medicare PECOS PAC ID | 5294262044 |
|---|---|
| Medicare Enrollment ID | O20241218002466 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669039178 | NPI | - | NPPES |
| 3138509 | Medicaid | NH | |
| 3147125 | Medicaid | NH | |
| 3118551 | Medicaid | NH | |
| 3149511 | Medicaid | NH | |
| 3148512 | Medicaid | NH | |
| 3138507 | Medicaid | NH | |
| 3138508 | Medicaid | NH | |
| 3147950 | 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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