Organization
BLUE CHANNEL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAIA LONGENECKER (OWNER)
(720) 295-7548
Entity
Organization
Contact information
Practice address
14901 E HAMPDEN AVE STE 120, AURORA, CO 80014-5037
(720) 295-7548
Mailing address
5460 WARD RD STE 150, ARVADA, CO 80002-1828
(720) 295-7548
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000190521
—
CO
Enumeration date
06/18/2022
Last updated
06/12/2023
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