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General NPI Number Information
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NPI Number | 1609596162
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Entity Type | Organization
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Legal Business Name | BLUE SKY COUNSELING, LLC
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1801 S 23RD ST STE 4
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City | FORT PIERCE
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State | FL
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Zip | 34950-4830
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Country | US
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Telephone | 772-801-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 S 23RD ST STE 4
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City | FORT PIERCE
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State | FL
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Zip | 34950-4830
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Country | US
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Telephone | 772-801-5192
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ERNESTO PERDOMO CARMONA
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Credential | BCBA
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Telephone | 772-801-5192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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