Provider Demographics
NPI:1386109957
Name:BLUE SKY MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:BLUE SKY MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:218-831-3715
Mailing Address - Street 1:14362 107TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-8905
Mailing Address - Country:US
Mailing Address - Phone:218-831-3715
Mailing Address - Fax:
Practice Address - Street 1:14362 107TH ST SE
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8905
Practice Address - Country:US
Practice Address - Phone:218-831-3715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00596OtherBOARD OF BEHAVIORAL HEALTH
MN1730526419OtherNPI