Healthcare Provider Details

I. General information

NPI: 1184945958
Provider Name (Legal Business Name): KIMBERLY L LIENEMANN LIMHP NE; LPC-MH SD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N LAWLER ST
MITCHELL SD
57301
US

IV. Provider business mailing address

705 E 41ST ST STE 200
SIOUX FALLS SD
57105-6048
US

V. Phone/Fax

Practice location:
  • Phone: 605-444-7500
  • Fax:
Mailing address:
  • Phone: 605-444-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number772
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10025890200
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: