Organization
BLUE PINE PSYCH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH MARY SWAN MSW (OWNER/CEO)
(231) 620-6085
Entity
Organization
Contact information
Practice address
19 WATER ST, MILFORD, OH 45150-1104
(231) 620-6085
Mailing address
19 WATER ST, MILFORD, OH 45150-1104
(231) 620-6085
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689295412
NPI
OH
Enumeration date
01/31/2024
Last updated
01/31/2024
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