Blue Rider Expressive Therapy LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BLUE RIDER EXPRESSIVE THERAPY LLC

Practice address

2528 Dwight Cochran Rd
Duck River, TN 38454-3434

Phone

(517) 215-6766

NPI assigned

Apr 9, 2020

Last updated

Feb 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Jean WattsNPI 1700251386

Title

Owner

Phone

(517) 215-6766

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Blue Rider Expressive Therapy PLLC

  • Mental Health Counselor
  • Duck River, TN
  • NPI 1619823606
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Jean Watts, LLPC

  • Mental Health Counselor
  • Brighton, MI
  • NPI 1700251386
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1477172666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 DWIGHT COCHRAN RD",
            "city": "DUCK RIVER",
            "state": "TN",
            "postal_code": "384543434",
            "telephone_number": "517-215-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 DWIGHT COCHRAN RD",
            "city": "DUCK RIVER",
            "state": "TN",
            "postal_code": "384543434",
            "telephone_number": "517-215-6766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3247 W Cohoctah Rd",
            "address_purpose": "LOCATION",
            "city": "Fowlerville",
            "state": "MI",
            "postal_code": "488369584",
            "country_code": "US",
            "telephone_number": "517-215-6766",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8123 Grand River Rd",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MI",
            "postal_code": "481149464",
            "country_code": "US",
            "telephone_number": "517-215-6766",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7215 N Latson Rd",
            "address_purpose": "LOCATION",
            "city": "Howell",
            "state": "MI",
            "postal_code": "488559258",
            "country_code": "US",
            "telephone_number": "517-215-6766",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE RIDER EXPRESSIVE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-09",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "WATTS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-215-6766"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Rider Expressive Therapy PLLC
• Victoria Elizabeth Daly, RD

• Professional Counselor in Duck River, TN
• Providers in Duck River, TN by specialty
• Professional Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.