Provider Demographics
NPI:1427853662
Name:BLUE SKY MIND LLC
Entity type:Organization
Organization Name:BLUE SKY MIND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGEON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-473-0150
Mailing Address - Street 1:39 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1593
Mailing Address - Country:US
Mailing Address - Phone:313-473-0150
Mailing Address - Fax:313-490-3180
Practice Address - Street 1:39 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1593
Practice Address - Country:US
Practice Address - Phone:313-473-0150
Practice Address - Fax:313-490-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty