| NPI | 1962608570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE ELIZABETH ELLIS Clinical Social Worker 605-271-1348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: SD 1936) |
| Additional Taxonomies | 251S00000X (Licence: IA 06783) |
| 251S00000X (Licence: MN 18354) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2011-07-01 |