Provider Demographics
NPI:1720844756
Name:MY BLUE SKIES LLC
Entity Type:Organization
Organization Name:MY BLUE SKIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNAZITO-WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-546-6920
Mailing Address - Street 1:7218 TALL OAK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-5650
Mailing Address - Country:US
Mailing Address - Phone:314-546-6920
Mailing Address - Fax:
Practice Address - Street 1:2026 S BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-2404
Practice Address - Country:US
Practice Address - Phone:314-375-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health