Provider Demographics
NPI:1932386869
Name:BLUE SKY BEHAVIORAL SERVICES INC.
Entity Type:Organization
Organization Name:BLUE SKY BEHAVIORAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-949-8444
Mailing Address - Street 1:512 SHELL DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3771
Mailing Address - Country:US
Mailing Address - Phone:530-949-8444
Mailing Address - Fax:
Practice Address - Street 1:1320 YUBA ST STE 214
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1005
Practice Address - Country:US
Practice Address - Phone:530-949-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty