MEDICARE: SHELYSSA SANDRALYN THEEL

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	LPC-21193	SD

General Provider Information

NPI Number	:	1922952563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELYSSA SANDRALYN THEEL

Provider Business Mailing Address
First Line	:	522 7TH ST STE 202
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2756
Country	:	US
Telephone Number	:	605-416-9904
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 7TH ST STE 202
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2756
Country	:	US
Telephone Number	:	605-416-9904
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “ SHELYSSA SANDRALYN THEEL ” Practice Location

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