Provider Demographics
NPI:1710011176
Name:BLUESKYES, ROMAN (LMFT)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:BLUESKYES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3710
Mailing Address - Country:US
Mailing Address - Phone:310-837-6647
Mailing Address - Fax:310-837-6647
Practice Address - Street 1:3831 HUGHES AVE STE 708
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-838-4403
Practice Address - Fax:888-231-5872
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist