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1103 Jenson Ave Se Unit 2 Watertown SD 57201-5259 | |
| (605) 370-4442 | |
| (605) 878-2211 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1103 Jenson Ave Se Unit 2, Watertown, South Dakota |
| Authorized Official Name and Position | Darla Jean Huffman (OWNER) |
| Authorized Official Contact | 6053704442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1103 Jenson Ave Se Unit 2 Watertown SD 57201-5259 Ph: (605) 370-4442 | 1103 Jenson Ave Se Unit 2 Watertown SD 57201-5259 Ph: (605) 370-4442 |
| NPI Number | 1356859706 |
|---|---|
| Provider Enumeration Date | 01/19/2018 |
| Last Update Date | 02/10/2024 |
| Certification Date | 02/10/2024 |
| Medicare PECOS PAC ID | 6709223803 |
|---|---|
| Medicare Enrollment ID | O20240326000002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356859706 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| Provider Name | Darla J Doop Huffman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205131208 PECOS PAC ID: 7517304611 Enrollment ID: I20240429002642 |
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