Healthcare Provider Details

I. General information

NPI: 1689837726
Provider Name (Legal Business Name): ST JOSEPHS INDIAN SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N MAIN AVE
CHAMBERLAIN SD
57325
US

IV. Provider business mailing address

1301 N MAIN AVE
CHAMBERLAIN SD
57325
US

V. Phone/Fax

Practice location:
  • Phone: 605-234-3401
  • Fax:
Mailing address:
  • Phone: 605-234-3401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE TYRELL
Title or Position: EXECUTIVE DIRECTOR OF CHILD SERVICE
Credential:
Phone: 605-234-3401