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2404 Jackson Blvd Rapid City SD 57702-3450 | |
| (605) 737-0769 | |
| (605) 721-1196 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 2404 Jackson Blvd, Rapid City, South Dakota |
| Authorized Official Name and Position | Susan Chamberlain Hayman (DIRECTOR) |
| Authorized Official Contact | 6057370769 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2404 Jackson Blvd Rapid City SD 57702-3450 Ph: (605) 737-0769 | 2404 Jackson Blvd Rapid City SD 57702-3450 Ph: (605) 737-0769 |
| NPI Number | 1407949084 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407949084 | NPI | - | NPPES |
| 6575560 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | SD LPC-MH 2081 (South Dakota) | Primary |
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