Healthcare Provider Details

I. General information

NPI: 1033819636
Provider Name (Legal Business Name): TOMMIE RAE MCLAUGHLLIN BSCJ/HS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 QUINCY ST
RAPID CITY SD
57701-5770
US

IV. Provider business mailing address

6872 POLK ST
SUMMERSET SD
57718-9228
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-7262
  • Fax:
Mailing address:
  • Phone: 605-454-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: