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Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)

Provider NPI: 1629593256

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
123 19TH ST NE  WATERTOWN, SD 57201-2823 US
Tel: 605-886-0123  Fax: 605-886-5447

Business Mailing Address:
PO BOX 1030  WATERTOWN, SD 57201-6030 US
Tel: 605-886-0123  Fax: 605-886-5447

NPI Information:
NPI: 1629593256
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 101YA0400X





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