Blue Water Therapists, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BLUE WATER THERAPISTS, PLLC

Practice address

1010 Blue Water Dr
Canyon Lake, TX 78133-5584

Phone

(830) 730-2705

NPI assigned

Aug 12, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jill Marie Ingersoll, LCSWNPI 1912760901

Title

Managing Member

Phone

(830) 730-2705

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jill Marie Ingersoll, LCSW

  • Clinical Social Worker
  • Canyon Lake, TX
  • NPI 1912760901
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1093546152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 BLUE WATER DR",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781335584",
            "telephone_number": "808-489-5438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 BLUE WATER DR",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781335584",
            "telephone_number": "830-730-2705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER THERAPISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-12",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-11",
        "status": "A",
        "authorized_official_last_name": "INGERSOLL",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "830-730-2705",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Penaranda Balongoy, NP
• Cecilia Maria Belcher, M.A. CCC/SLP
• Tawnya Bensinger, PHARMD
• Jessica Ann Bentley, LPC-A
• Bexarcare Pediatric Home Healthcare
• Brian Bodkin
• Brandon Grimm D.C. P.a.
• Brookshire Brothers Inc
• Brian Bumphus, PRSS
• Shawn Burch, LPC

• Clinical Social Worker in Canyon Lake, TX
• Providers in Canyon Lake, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.