Provider Demographics
NPI:1265051403
Name:BLUE SKIES COUNSELING
Entity type:Organization
Organization Name:BLUE SKIES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-413-3740
Mailing Address - Street 1:1166 N 220 W UNIT 128
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9074
Mailing Address - Country:US
Mailing Address - Phone:801-413-3740
Mailing Address - Fax:
Practice Address - Street 1:2150 S 1300 E STE 500
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4375
Practice Address - Country:US
Practice Address - Phone:801-413-3740
Practice Address - Fax:801-931-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1861820813Medicaid