Healthcare Provider Details

I. General information

NPI: 1992199988
Provider Name (Legal Business Name): SUZETTE WASVICK COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 JACKSON BLVD STE 5
RAPID CITY SD
57702-3400
US

IV. Provider business mailing address

PO BOX 763
HILL CITY SD
57745-0763
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-8647
  • Fax: 605-341-8647
Mailing address:
  • Phone: 605-390-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2264
License Number StateSD

VIII. Authorized Official

Name: SUZETTE WASVICK
Title or Position: OWNER
Credential: LPC-MH
Phone: 605-390-8791