Provider Demographics
NPI:1083493092
Name:INDIGO SKY COUNSELING, LLC
Entity Type:Organization
Organization Name:INDIGO SKY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-231-8550
Mailing Address - Street 1:4 CAVE RD
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:NM
Mailing Address - Zip Code:87010-9730
Mailing Address - Country:US
Mailing Address - Phone:505-231-8550
Mailing Address - Fax:
Practice Address - Street 1:2205 MIGUEL CHAVEZ RD STE B3
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6914
Practice Address - Country:US
Practice Address - Phone:505-231-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty