Organization Name: | CREDO COUNSELING |
NPI Number: | 1013302074 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARLEEN MICHELLE BRYANT (CLINICAL THERAPIST) |
Mailing Address: | 5024 S Bur Oak Pl Ste 212 Sioux Falls |
State: | SD US |
Postal Code: | 571082238 |
Phone Number: | 6052123276 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2015 |
NPI Last Update Date: | 04/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2182 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |