Healthcare Provider Details

I. General information

NPI: 1487796439
Provider Name (Legal Business Name): GREGORY HOWARD MSW, PHD, CSW-PIP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 605-716-7300
  • Fax: 605-716-1300
Mailing address:
  • Phone: 605-716-7300
  • 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
Identifier4995651
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerWELLMARK BCBS PROVIDER #
# 2
Identifier6570303
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: