Healthcare Provider Details

I. General information

NPI: 1659217909
Provider Name (Legal Business Name): COLE MILLS CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 E 3RD ST
SIOUX FALLS SD
57103-6650
US

IV. Provider business mailing address

500 E WILLOW ST
HARRISBURG SD
57032-2019
US

V. Phone/Fax

Practice location:
  • Phone: 605-965-3199
  • Fax:
Mailing address:
  • Phone: 712-230-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7025
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: