Healthcare Provider Details

I. General information

NPI: 1992073951
Provider Name (Legal Business Name): ANDREA UCKERT LPC-MH, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 5TH AVE STE 3
BROOKINGS SD
57006
US

IV. Provider business mailing address

619 5TH AVE STE 3
BROOKINGS SD
57006-1454
US

V. Phone/Fax

Practice location:
  • Phone: 605-592-5300
  • Fax: 605-696-7977
Mailing address:
  • Phone: 605-592-5300
  • Fax: 605-696-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20334
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: