Healthcare Provider Details

I. General information

NPI: 1487419909
Provider Name (Legal Business Name): SKY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E BURNSVILLE PKWY
BURNSVILLE MN
55337-2868
US

IV. Provider business mailing address

401 E BURNSVILLE PKWY APT 335
BURNSVILLE MN
55337-2858
US

V. Phone/Fax

Practice location:
  • Phone: 612-401-8054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: FATUMA FARAH
Title or Position: PROGRAM MANAGER
Credential: LPCC
Phone: 612-401-8054