Healthcare Provider Details

I. General information

NPI: 1790823060
Provider Name (Legal Business Name): SKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BELLEVUE AVE
SAINT LOUIS MO
63117-1701
US

IV. Provider business mailing address

1201 BELLEVUE AVE
SAINT LOUIS MO
63117-1701
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-4488
  • Fax: 314-647-6305
Mailing address:
  • Phone: 314-647-4488
  • Fax: 314-647-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ADAM J SKY
Title or Position: PRESIDENT, PRIMARY MEMBER
Credential: MD
Phone: 314-647-4488