Provider Demographics
NPI:1992361679
Name:PONDEROSA SKY COUNSELING LLC
Entity Type:Organization
Organization Name:PONDEROSA SKY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURROGATE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-338-0488
Mailing Address - Street 1:4230 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-3770
Mailing Address - Country:US
Mailing Address - Phone:719-338-0488
Mailing Address - Fax:
Practice Address - Street 1:4230 TIMBER LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-3770
Practice Address - Country:US
Practice Address - Phone:719-338-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty