Healthcare Provider Details

I. General information

NPI: 1134300973
Provider Name (Legal Business Name): GREGORY HOWARD, PH.D., CSW-PIP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 SAINT ANNE ST SUITE #101
RAPID CITY SD
57701-4694
US

IV. Provider business mailing address

636 SAINT ANNE ST SUITE #101
RAPID CITY SD
57701-4694
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-1300
  • Fax: 605-716-1300
Mailing address:
  • Phone: 605-716-1300
  • Fax: 605-716-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1381
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier6570303
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: DR. GREGORY HOWARD
Title or Position: PRESIDENT
Credential: MSW PHD CSW-PIP
Phone: 605-716-1300