MEDICARE: ALYSSA JO PROTSCH-HUSMAN LPC-MH-SUPERVISEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	20918	SD
2	101YP2500X	Professional Counselor	30925	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC20918	OTHER	SD	SD DEPARTMENT OF SOCIAL SERVICES

General Provider Information

NPI Number	:	1063244770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA JO PROTSCH-HUSMAN LPC-MH-SUPERVISEE

Provider Business Mailing Address
First Line	:	5515 E 18TH ST STE 130
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-2870
Country	:	US
Telephone Number	:	605-600-1733
Fax Number	:

Provider Business Practice Location Address
First Line	:	5515 E 18TH ST STE 130
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-2870
Country	:	US
Telephone Number	:	605-600-1733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	02/10/2025

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