Provider Demographics
NPI:1659575637
Name:BLUE SKY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:BLUE SKY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL SUPPORT CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:RICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:970-946-0604
Mailing Address - Street 1:215 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4351
Mailing Address - Country:US
Mailing Address - Phone:970-946-0604
Mailing Address - Fax:970-382-9301
Practice Address - Street 1:215 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4351
Practice Address - Country:US
Practice Address - Phone:970-946-0604
Practice Address - Fax:970-382-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD3878Medicaid
CO1588790414OtherINDIVIDUAL NPI NUMBER