Provider Demographics
NPI:1861206583
Name:BLUEGREEN COUNSELING & WELLNESS, LLC
Entity type:Organization
Organization Name:BLUEGREEN COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FREDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-PIP
Authorized Official - Phone:210-846-9037
Mailing Address - Street 1:1601 MOUNT RUSHMORE RD STE 3-202
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4591
Mailing Address - Country:US
Mailing Address - Phone:210-846-9037
Mailing Address - Fax:
Practice Address - Street 1:1601 MOUNT RUSHMORE RD STE 3-202
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4591
Practice Address - Country:US
Practice Address - Phone:210-846-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty