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General NPI Number Information
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NPI Number | 1255106340
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Entity Type | Organization
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Legal Business Name | CHARLIE BLUE THERAPY LLC
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 3370 LONG PRAIRIE RD STE 650
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City | FLOWER MOUND
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State | TX
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Zip | 75022-3000
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Country | US
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Telephone | 469-557-2997
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 OLYMPIA DR UNIT 270118
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City | FLOWER MOUND
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State | TX
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Zip | 75027-0049
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Country | US
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Telephone | 469-557-2997
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JONATHON CURLETT
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Credential |
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Telephone | 469-557-2997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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