| Bridgewater Behavioral Health, Llc | |
|
902 Columbus St Rapid City SD 57701-3543 | |
| (605) 791-1514 | |
| (844) 831-2349 |
| Full Name | Bridgewater Behavioral Health, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 902 Columbus St, Rapid City, South Dakota |
| Authorized Official Name and Position | Genni L Goschke (PRESIDENT) |
| Authorized Official Contact | 6057911514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgewater Behavioral Health, Llc Po Box 1990 Rapid City SD 57709-1990 Ph: (605) 791-1514 | Bridgewater Behavioral Health, Llc 902 Columbus St Rapid City SD 57701-3543 Ph: (605) 791-1514 |
| NPI Number | 1588048201 |
|---|---|
| Provider Enumeration Date | 07/13/2015 |
| Last Update Date | 07/13/2015 |
| Medicare PECOS PAC ID | 7911216502 |
|---|---|
| Medicare Enrollment ID | O20151021003194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588048201 | NPI | - | NPPES |
| 1679550065 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 479 (South Dakota) | Primary |
| Provider Name | Genni L Goschke |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679550065 PECOS PAC ID: 8729019278 Enrollment ID: I20090915000436 |
| Provider Name | Eric D Traub |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1356786917 PECOS PAC ID: 7719126523 Enrollment ID: I20130626000466 |
| Provider Name | Chantal M Peterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427469519 PECOS PAC ID: 4981820024 Enrollment ID: I20140724002338 |
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