Provider Demographics
NPI:1417681222
Name:BLUE CHANNEL THERAPY
Entity Type:Organization
Organization Name:BLUE CHANNEL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-989-0021
Mailing Address - Street 1:5460 WARD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1828
Mailing Address - Country:US
Mailing Address - Phone:720-795-7548
Mailing Address - Fax:
Practice Address - Street 1:10465 MELODY DR STE 215
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4125
Practice Address - Country:US
Practice Address - Phone:720-295-7548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1811587199
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000190521Medicaid