Healthcare Provider Details

I. General information

NPI: 1285509968
Provider Name (Legal Business Name): SKYLAR MCMURTREY LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MADISON AVE
MANKATO MN
56001-6109
US

IV. Provider business mailing address

2043 CLARK ST APT 127
SAINT PETER MN
56082-7533
US

V. Phone/Fax

Practice location:
  • Phone: 507-931-8040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307231
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: