Provider Demographics
NPI:1972364297
Name:BLUE OAK COUNSELING LLC
Entity type:Organization
Organization Name:BLUE OAK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:802-321-3997
Mailing Address - Street 1:4 CARMICHAEL ST
Mailing Address - Street 2:SUITE 111 PMB 160
Mailing Address - City:ESSEX
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3195
Mailing Address - Country:US
Mailing Address - Phone:802-321-3997
Mailing Address - Fax:
Practice Address - Street 1:224 STIRRUP CIR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7340
Practice Address - Country:US
Practice Address - Phone:802-321-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health