Healthcare Provider Details

I. General information

NPI: 1760386338
Provider Name (Legal Business Name): JACQUELYN GALLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 JACKSON BLVD
RAPID CITY SD
57702-3481
US

IV. Provider business mailing address

7999 COUNTRY VIEW PL
RAPID CITY SD
57702-8743
US

V. Phone/Fax

Practice location:
  • Phone: 605-939-1210
  • Fax: 712-248-8041
Mailing address:
  • Phone: 605-939-1210
  • Fax: 712-248-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELYN GALLES
Title or Position: OWNER
Credential: MS, NCC, LPC-MH
Phone: 605-923-8244