| 2degreechange Llc | |
|
4301 W 57th St Ste 100 Sioux Falls SD 57108-2255 | |
| (605) 335-1516 | |
| Not Available |
| Full Name | 2degreechange Llc |
|---|---|
| Speciality | Counselor |
| Location | 4301 W 57th St Ste 100, Sioux Falls, South Dakota |
| Authorized Official Name and Position | Earl Gordon Witt (OWNER) |
| Authorized Official Contact | 6055951583 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 2degreechange Llc 47352 299th St Beresford SD 57004-6733 Ph: (605) 595-1583 | 2degreechange Llc 4301 W 57th St Ste 100 Sioux Falls SD 57108-2255 Ph: (605) 335-1516 |
| NPI Number | 1043984727 |
|---|---|
| Provider Enumeration Date | 08/05/2021 |
| Last Update Date | 08/05/2021 |
| Certification Date | 08/05/2021 |
| Medicare PECOS PAC ID | 1850833591 |
|---|---|
| Medicare Enrollment ID | O20240610000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043984727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Earl Gordon Witt |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1366427163 PECOS PAC ID: 2769924406 Enrollment ID: I20240610000654 |
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