| NPI | 1881181642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON JEAN MAXWELL Owner 605-641-8880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SD 530) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SD 530) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2019-03-12 |