Healthcare Provider Details

I. General information

NPI: 1316609720
Provider Name (Legal Business Name): SKY RANCH BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 5TH ST STE 100
SIOUX CITY IA
51101-1510
US

IV. Provider business mailing address

505 5TH ST STE 100
SIOUX CITY IA
51101-1510
US

V. Phone/Fax

Practice location:
  • Phone: 712-277-2007
  • Fax: 712-277-2189
Mailing address:
  • Phone: 712-277-2007
  • Fax: 712-277-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA BERTRAND
Title or Position: EXECUTIVE DIRECTOR
Credential: TLMHC
Phone: 712-277-2007