Healthcare Provider Details

I. General information

NPI: 1457979007
Provider Name (Legal Business Name): NICOLE WERON LPC-MH, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 W MAIN ST
RAPID CITY SD
57702-2575
US

IV. Provider business mailing address

23433 SAND CT
RAPID CITY SD
57702-6596
US

V. Phone/Fax

Practice location:
  • Phone: 605-228-9233
  • Fax:
Mailing address:
  • Phone: 605-228-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24193
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30777
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: