MEDICARE: MARISSA KAY HASTINGS LPC, LAC, NCC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	23071954	SD
2	101YM0800X	Mental Health Counselor	20946	SD

General Provider Information

NPI Number	:	1376409243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA KAY HASTINGS LPC, LAC, NCC

Provider Business Mailing Address
First Line	:	2121 S SILVERTHORNE AVE APT 203
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-7689
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N DAKOTA AVE STE 310
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-6026
Country	:	US
Telephone Number	:	712-470-4022
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/23/2026

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