Provider Demographics
NPI:1396508057
Name:BLUE STAR THERAPY, LLC
Entity type:Organization
Organization Name:BLUE STAR THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNNA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:620-544-4357
Mailing Address - Street 1:1006 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951-2858
Mailing Address - Country:US
Mailing Address - Phone:620-544-4357
Mailing Address - Fax:
Practice Address - Street 1:1006 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2858
Practice Address - Country:US
Practice Address - Phone:620-544-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE STAR THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty