| Blue Heron Wellness, Llc | |
|
515 S Barstow St Ste 117 Eau Claire WI 54701-2618 | |
| (715) 229-3019 | |
| (715) 229-3268 |
| Full Name | Blue Heron Wellness, Llc |
|---|---|
| Speciality | Counselor |
| Location | 515 S Barstow St Ste 117, Eau Claire, Wisconsin |
| Authorized Official Name and Position | Elizabeth Caroline Davison (OWNER/LPC) |
| Authorized Official Contact | 7152293019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Heron Wellness, Llc 515 S Barstow St Ste 117 Eau Claire WI 54701-2618 Ph: (715) 229-3019 | Blue Heron Wellness, Llc 515 S Barstow St Ste 117 Eau Claire WI 54701-2618 Ph: (715) 229-3019 |
| NPI Number | 1437907086 |
|---|---|
| Provider Enumeration Date | 05/08/2024 |
| Last Update Date | 11/19/2024 |
| Certification Date | 11/19/2024 |
| Medicare PECOS PAC ID | 8921534264 |
|---|---|
| Medicare Enrollment ID | O20241210000950 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437907086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Elizabeth Caroline Davison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154894657 PECOS PAC ID: 7810330370 Enrollment ID: I20240212002902 |
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