| Blue Channel Therapy | |
|
5460 Ward Rd Ste 150 Arvada CO 80002-1828 | |
| (720) 295-7548 | |
| Not Available |
| Full Name | Blue Channel Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 5460 Ward Rd Ste 150, Arvada, Colorado |
| Authorized Official Name and Position | Maia Longenecker (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7202957548 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Channel Therapy 5460 Ward Rd Ste 150 Arvada CO 80002-1828 Ph: (720) 295-7548 | Blue Channel Therapy 5460 Ward Rd Ste 150 Arvada CO 80002-1828 Ph: (720) 295-7548 |
| NPI Number | 1811587199 |
|---|---|
| Provider Enumeration Date | 01/21/2021 |
| Last Update Date | 06/12/2023 |
| Certification Date | 06/12/2023 |
| Medicare PECOS PAC ID | 0941653364 |
|---|---|
| Medicare Enrollment ID | O20240201000494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811587199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Maia A Longenecker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497180129 PECOS PAC ID: 4981994795 Enrollment ID: I20160607002569 |
| Provider Name | Lynne Cole |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205373065 PECOS PAC ID: 7618312869 Enrollment ID: I20240228001084 |
| Provider Name | Kathleen Marie Watson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942536040 PECOS PAC ID: 9032554183 Enrollment ID: I20240228001613 |
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