Provider Demographics
NPI:1548737778
Name:BLUE SKY RANCH
Entity Type:Organization
Organization Name:BLUE SKY RANCH
Other - Org Name:BSR THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-648-2745
Mailing Address - Street 1:8830 S HYDRAULIC ST
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-7232
Mailing Address - Country:US
Mailing Address - Phone:316-648-2745
Mailing Address - Fax:
Practice Address - Street 1:8830 S HYDRAULIC ST
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-7232
Practice Address - Country:US
Practice Address - Phone:316-648-2745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE SKY RANCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-25
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty