| Kris Jeakins, Llc | |
|
3618 Canyon Lake Dr Ste 107 Rapid City SD 57702-3129 | |
| (605) 430-4214 | |
| Not Available |
| Full Name | Kris Jeakins, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3618 Canyon Lake Dr Ste 107, Rapid City, South Dakota |
| Authorized Official Name and Position | Kris Jeakins (OWNER) |
| Authorized Official Contact | 6054304214 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kris Jeakins, Llc 109 Springer Dr Box Elder SD 57719-9620 Ph: (605) 430-4214 | Kris Jeakins, Llc 3618 Canyon Lake Dr Ste 107 Rapid City SD 57702-3129 Ph: (605) 430-4214 |
| NPI Number | 1275265761 |
|---|---|
| Provider Enumeration Date | 06/24/2022 |
| Last Update Date | 06/24/2022 |
| Certification Date | 06/24/2022 |
| Medicare PECOS PAC ID | 7810437886 |
|---|---|
| Medicare Enrollment ID | O20240905003375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275265761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kris Jeakins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609346006 PECOS PAC ID: 8729528799 Enrollment ID: I20240905003428 |
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