Healthcare Provider Details

I. General information

NPI: 1790154094
Provider Name (Legal Business Name): MICHELLE VENEKLASEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 JACKSON BLVD STE 6
RAPID CITY SD
57702-3400
US

IV. Provider business mailing address

2640 JACKSON BLVD STE 6
RAPID CITY SD
57702-3400
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-8647
  • Fax: 605-341-0489
Mailing address:
  • Phone: 605-341-8947
  • Fax: 605-341-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCMH2285
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: