Healthcare Provider Details

I. General information

NPI: 1841857455
Provider Name (Legal Business Name): BLUE SKY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S MAIN AVE
LOVINGTON NM
88260-5620
US

IV. Provider business mailing address

PO BOX 1531
HOBBS NM
88241-1531
US

V. Phone/Fax

Practice location:
  • Phone: 575-552-1184
  • Fax:
Mailing address:
  • Phone: 575-552-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M MARTIN
Title or Position: CHIEF EXECUTIVE OFFICER (CEO)
Credential: BSE, MA
Phone: 575-552-1184