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General NPI Number Information
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NPI Number | 1932386869
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Entity Type | Organization
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Legal Business Name | BLUE SKY BEHAVIORAL SERVICES INC.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 1320 YUBA ST STE 214
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City | REDDING
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State | CA
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Zip | 96001-1005
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Country | US
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Telephone | 530-949-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 512 SHELL DR
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City | REDDING
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State | CA
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Zip | 96003-3771
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Country | US
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Telephone | 530-949-8444
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MATTHEW D KRAUSE
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Credential | PH.D.
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Telephone | 530-949-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 21373
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License Number State | CA
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