Healthcare Provider Details

I. General information

NPI: 1790709145
Provider Name (Legal Business Name): PSYCHOLOGICAL EVALUATION THERAPY & RESEARCH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CANYON LAKE DRIVE
RAPID CITY SD
57702
US

IV. Provider business mailing address

3601 CANYON LAKE DRIVE
RAPID CITY SD
57702
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-8647
  • Fax: 605-341-0489
Mailing address:
  • Phone: 605-341-8647
  • Fax: 605-341-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number123
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number123
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number123
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number123
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number123
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number123
License Number StateSD
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number123
License Number StateSD
# 8
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number123
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. DEWEY J ERTZ
Title or Position: PRESIDENT PSYCHOLOGIST
Credential: ED D
Phone: 605-341-8647