Healthcare Provider Details

I. General information

NPI: 1811001985
Provider Name (Legal Business Name): THREE RIVERS MENTAL HEALTH AND CHEMICAL DEPENDENCY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 EAST 4TH STREET
LEMMON SD
57638-0447
US

IV. Provider business mailing address

11 EAST 4TH ST. P.O. BOX 447
LEMMON SD
57638-0447
US

V. Phone/Fax

Practice location:
  • Phone: 605-374-3862
  • Fax: 605-374-3864
Mailing address:
  • Phone: 605-374-3862
  • Fax: 605-374-3864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1162
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1082
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1948
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC1098
License Number StateSD

VIII. Authorized Official

Name: LAURIE BERG
Title or Position: BILLING MANAGER
Credential:
Phone: 605-374-3862