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General NPI Number Information
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NPI Number | 1952959363
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Entity Type | Organization
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Legal Business Name | BLUE SKIES MINDFULNESS & WELLNESS, LLC
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2040 SEASONS RIDGE BLVD
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City | EVANSVILLE
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State | IN
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Zip | 47715-6534
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Country | US
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Telephone | 812-604-7718
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Fax | 812-636-1333
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Provider Business Mailing Address
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Address Line | 5444 E. INDIANA ST PMB 170
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City | EVANSVILLE
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State | IN
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Zip | 47715-2857
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Country | US
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Telephone | 812-418-3986
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Fax | 812-636-1333
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Authorized Official
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Title or Position | TIN OWNER
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Name | LORI ANNE RILEY
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Credential | LCSW
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Telephone | 812-604-7718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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