Healthcare Provider Details

I. General information

NPI: 1104950195
Provider Name (Legal Business Name): SLATE CREEK COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 COTEAU ST
PIERRE SD
57501-3187
US

IV. Provider business mailing address

PO BOX 412
PIERRE SD
57501-0412
US

V. Phone/Fax

Practice location:
  • Phone: 605-220-1093
  • Fax:
Mailing address:
  • Phone: 605-220-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN RAPP
Title or Position: PRESIDENT
Credential: LCSW-PIP
Phone: 605-484-9679