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General NPI Number Information
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NPI Number | 1144655507
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Entity Type | Organization
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Legal Business Name | BLUE SKIES BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 15525 POMERADO RD SUITE B-1
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City | POWAY
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State | CA
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Zip | 92064-2435
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Country | US
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Telephone | 858-243-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 15525 POMERADO RD SUITE B-1
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City | POWAY
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State | CA
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Zip | 92064-2435
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Country | US
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Telephone | 858-243-3245
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIKA SWIFT HOLTERMANN
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Credential | PHD
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Telephone | 858-243-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 24132
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License Number State | CA
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