# BLUE HERON THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407770324
- **Authorized official:** ELLEN TERAN LSCSW (OWNER)
- **Authorized official phone:** (316) 247-4737

## Contact information

- **Practice address:** 200 N BROADWAY AVE STE 235, WICHITA, KS 67202-2300
- **Practice address phone:** (316) 247-4737
- **Mailing address:** 200 N BROADWAY AVE STE 235, WICHITA, KS 67202-2300
- **Mailing address phone:** (316) 247-4737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2026
- **Last updated:** 08/05/2026