Healthcare Provider Details

I. General information

NPI: 1871456731
Provider Name (Legal Business Name): HANNAH CLARK-VAN BALLEGOOYEN LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LINDSAY DR
AURORA SD
57002-8507
US

IV. Provider business mailing address

109 LINDSAY DR
AURORA SD
57002-8507
US

V. Phone/Fax

Practice location:
  • Phone: 605-553-3457
  • Fax:
Mailing address:
  • Phone: 605-553-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC20953
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: