Healthcare Provider Details

I. General information

NPI: 1467372623
Provider Name (Legal Business Name): BLUE SKY MENTAL HEALTH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14504 GREENVIEW DR STE 202
LAUREL MD
20708-3225
US

IV. Provider business mailing address

10301 GEORGIA AVE STE 203W
SILVER SPRING MD
20902-5020
US

V. Phone/Fax

Practice location:
  • Phone: 240-377-0260
  • Fax: 240-386-1213
Mailing address:
  • Phone: 240-377-0260
  • Fax: 240-386-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JASON GADNER ELIASSAINT
Title or Position: PRESIDENT
Credential:
Phone: 240-865-3135