Indigo Skies LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

INDIGO SKIES LLC

Practice address

218 Montauk Drive
Greenville, SC 29607

Phone

(864) 546-8165

NPI assigned

Oct 18, 2022

Last updated

Dec 12, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brooke Mattison, LPCNPI 1487108452

Title

Owner

Phone

(864) 546-8165

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brooke Mattison, LPC

  • Professional Counselor
  • Mauldin, SC
  • NPI 1487108452
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1982320255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 829",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296620829",
            "telephone_number": "864-546-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 MONTAUK DRIVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29607",
            "telephone_number": "864-546-8165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO SKIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "MATTISON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-546-8165",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC LICENSURE",
            "identifier": "6395",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.