Healthcare Provider Details

I. General information

NPI: 1952959363
Provider Name (Legal Business Name): BLUE SKIES MINDFULNESS & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SEASONS RIDGE BLVD
EVANSVILLE IN
47715-6534
US

IV. Provider business mailing address

5444 E. INDIANA ST PMB 170
EVANSVILLE IN
47715-2857
US

V. Phone/Fax

Practice location:
  • Phone: 812-604-7718
  • Fax: 812-636-1333
Mailing address:
  • Phone: 812-418-3986
  • Fax: 812-636-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LORI ANNE RILEY
Title or Position: TIN OWNER
Credential: LCSW
Phone: 812-604-7718