Healthcare Provider Details

I. General information

NPI: 1922910413
Provider Name (Legal Business Name): BRIAN JONATHAN SKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 GREGORY RD
FORT COLLINS CO
80524-1500
US

IV. Provider business mailing address

623 GREGORY RD
FORT COLLINS CO
80524-1500
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-8482
  • Fax:
Mailing address:
  • Phone: 970-682-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0025339
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: