Provider Demographics
NPI:1518529775
Name:BLUE SKY COUNSELING LLC
Entity Type:Organization
Organization Name:BLUE SKY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARITAL & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LACZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-605-0799
Mailing Address - Street 1:28 RIVEREDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-2137
Mailing Address - Country:US
Mailing Address - Phone:860-605-0799
Mailing Address - Fax:
Practice Address - Street 1:85 RIVER RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3245
Practice Address - Country:US
Practice Address - Phone:860-605-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)