Provider Demographics
NPI:1346652187
Name:BLUE SKY COUNSELING CENTER CORPORATION
Entity Type:Organization
Organization Name:BLUE SKY COUNSELING CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNICA
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPCC26
Authorized Official - Phone:916-747-3799
Mailing Address - Street 1:2351 SUNSET BLVD
Mailing Address - Street 2:SUITE 170-241
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4338
Mailing Address - Country:US
Mailing Address - Phone:916-747-3799
Mailing Address - Fax:916-756-0352
Practice Address - Street 1:1899 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7979
Practice Address - Country:US
Practice Address - Phone:916-747-3799
Practice Address - Fax:916-756-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC26251S00000X
COLPC6072251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health