=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225110539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE SKY BEHAVIORAL HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 E CINCINNATI AVE
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74403-5535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-681-1113
-----------------------------------------------------
Fax | 918-681-1116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2547 502 EAST CINCINNATI AVENUE,
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74402-2547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-681-1113
-----------------------------------------------------
Fax | 918-681-1116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. REBECCA TURNHAM
-----------------------------------------------------
Credential | CMII
-----------------------------------------------------
Telephone | 918-681-1113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------