Provider Demographics
NPI:1609418896
Name:BLUE SKY BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:BLUE SKY BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEELIMA
Authorized Official - Middle Name:GUTTI
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-233-7154
Mailing Address - Street 1:402B LEGACY PARK
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4315
Mailing Address - Country:US
Mailing Address - Phone:769-233-7154
Mailing Address - Fax:
Practice Address - Street 1:402B LEGACY PARK
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4315
Practice Address - Country:US
Practice Address - Phone:769-233-7154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty