Cedar Lakes Therapy, Llc | |
525 5th St Se Watertown SD 57201-4940 | |
(605) 880-7944 | |
Not Available |
Full Name | Cedar Lakes Therapy, Llc |
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Speciality | Clinic/Center |
Location | 525 5th St Se, Watertown, South Dakota |
Authorized Official Name and Position | Karla O Schupp (SOCIAL WORKER) |
Authorized Official Contact | 2314200536 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Cedar Lakes Therapy, Llc 525 5th St Se Watertown SD 57201-4940 Ph: (605) 880-7944 | Cedar Lakes Therapy, Llc 525 5th St Se Watertown SD 57201-4940 Ph: (605) 880-7944 |
NPI Number | 1982353959 |
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Provider Enumeration Date | 03/18/2022 |
Last Update Date | 11/10/2022 |
Certification Date | 11/10/2022 |
Medicare PECOS PAC ID | 3971973967 |
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Medicare Enrollment ID | O20230109002331 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982353959 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Provider Name | Karla Schupp |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1730428095 PECOS PAC ID: 9335496702 Enrollment ID: I20191127000403 |
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