NPIMap

Organization Active NPI

Blue Channel Therapy

  • Clinical Social Worker
  • Arvada, CO
National Provider Identifier
1811587199
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
BLUE CHANNEL THERAPY
Practice address
5460 Ward Rd Ste 150
Arvada, CO 80002-1828
Phone
(720) 295-7548
NPI assigned
Jan 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Maia Longenecker, LCSWNPI 1497180129
Title
Executive Director
Phone
(720) 295-7548

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

5460 Ward Rd Ste 150
Arvada, CO 80002-1828

Mailing address

5460 Ward Rd Ste 150
Arvada, CO 80002-1828
Phone (720) 295-7548

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240201000494 CO Part B Supplier - Clinic/Group Practice 0941653364 Receives reassigned benefits from 9 practitioners
Practice locations: Arvada, CO

National Provider Directory

National Provider Directory
Tax ID family
Blue Channel Therapy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5460 Ward Rd
Ste 305
Arvada, CO 80002
Phone (720) 255-1262

5460 Ward Rd
Ste 150
Arvada, CO 80002
Phone (720) 295-7548

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1811587199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5460 WARD RD STE 150",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800021828",
            "telephone_number": "720-295-7548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 WARD RD STE 150",
            "city": "ARVADA",
            "state": "CO",
            "postal_code": "800021828",
            "telephone_number": "720-295-7548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE CHANNEL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "LONGENECKER",
        "authorized_official_first_name": "MAIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "720-295-7548",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arvada, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.