Provider Demographics
NPI:1215910377
Name:BLUE RIVER COUNSELING ASSOCIATES INC
Entity type:Organization
Organization Name:BLUE RIVER COUNSELING ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRIFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:317-392-0171
Mailing Address - Street 1:15 S TOMPKINS ST
Mailing Address - Street 2:P O BOX 1042
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1205
Mailing Address - Country:US
Mailing Address - Phone:317-392-0171
Mailing Address - Fax:317-392-0171
Practice Address - Street 1:15 S TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1205
Practice Address - Country:US
Practice Address - Phone:317-392-0171
Practice Address - Fax:317-392-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001457A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty