# FOGGY PATH RANCH & WELLNESS, LLC

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

## Provider details

- **NPI number:** 1912715673
- **Authorized official:** HEATHER JACKSON LCPC (FOUNDER)
- **Authorized official phone:** (207) 352-3281

## Contact information

- **Practice address:** 37 FOGG LANE, BURLINGTON, ME 04417
- **Practice address phone:** (207) 352-3281
- **Mailing address:** PO BOX 62, BURLINGTON, ME 04417-0062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2024
- **Last updated:** 12/26/2024