Healthcare Provider Details

I. General information

NPI: 1316862436
Provider Name (Legal Business Name): SKY SOCIETY YOUTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 MERCURY LN
LANCASTER TX
75134-4172
US

IV. Provider business mailing address

1306 MERCURY LN
LANCASTER TX
75134-4172
US

V. Phone/Fax

Practice location:
  • Phone: 214-434-1098
  • Fax:
Mailing address:
  • Phone: 214-434-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DESTINY GUILLORY
Title or Position: LICENSED CHILD CARE ADMINISTRATOR
Credential: LCCA
Phone: 214-289-9868