Healthcare Provider Details

I. General information

NPI: 1598988172
Provider Name (Legal Business Name): BONNIE KAY WERPY RYE LPC-MH, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 4TH ST
BROOKINGS SD
57006-1954
US

IV. Provider business mailing address

PO BOX 8004
BROOKINGS SD
57006-8004
US

V. Phone/Fax

Practice location:
  • Phone: 605-696-7601
  • Fax:
Mailing address:
  • Phone: 605-696-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH 2071
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: