| Little Canyon Services Llc | |
|
310 S 26th St Ste 1 Spearfish SD 57783-3355 | |
| (605) 580-7358 | |
| (605) 559-0321 |
| Full Name | Little Canyon Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 310 S 26th St Ste 1, Spearfish, South Dakota |
| Authorized Official Name and Position | Michele Marie Clodfelder (OWNER) |
| Authorized Official Contact | 2182320889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Canyon Services Llc 310 S 26th St Ste 1 Spearfish SD 57783-3355 Ph: (605) 580-7358 | Little Canyon Services Llc 310 S 26th St Ste 1 Spearfish SD 57783-3355 Ph: (605) 580-7358 |
| NPI Number | 1457049504 |
|---|---|
| Provider Enumeration Date | 04/26/2023 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Medicare PECOS PAC ID | 8820441587 |
|---|---|
| Medicare Enrollment ID | O20240129004042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457049504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Michele Marie Clodfelder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194108829 PECOS PAC ID: 9739532490 Enrollment ID: I20240129004086 |
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