| Charlie Blue Therapy Llc | |
|
3370 Long Prairie Rd Ste 550 Flower Mound TX 75022-3000 | |
| (469) 557-2997 | |
| Not Available |
| Full Name | Charlie Blue Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3370 Long Prairie Rd Ste 550, Flower Mound, Texas |
| Authorized Official Name and Position | Jonathon Curlett (MANAGER) |
| Authorized Official Contact | 4695572997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charlie Blue Therapy Llc 2300 Olympia Dr Unit 270118 Flower Mound TX 75027-0049 Ph: (469) 955-1099 | Charlie Blue Therapy Llc 3370 Long Prairie Rd Ste 550 Flower Mound TX 75022-3000 Ph: (469) 557-2997 |
| NPI Number | 1255106340 |
|---|---|
| Provider Enumeration Date | 11/17/2023 |
| Last Update Date | 11/17/2023 |
| Certification Date | 11/16/2023 |
| Medicare PECOS PAC ID | 4385082965 |
|---|---|
| Medicare Enrollment ID | O20240402000773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255106340 | NPI | - | NPPES |
| Provider Name | Mae-lin Mendoza |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750632576 PECOS PAC ID: 6507204286 Enrollment ID: I20240401000310 |
| Provider Name | Jacey Coy |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1083900070 PECOS PAC ID: 7911345699 Enrollment ID: I20240401000401 |
| Provider Name | Alyssa Ruiz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841053220 PECOS PAC ID: 6709224496 Enrollment ID: I20240401000588 |
| Provider Name | Felicia Stacks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487713715 PECOS PAC ID: 1355789389 Enrollment ID: I20240409004228 |
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