Healthcare Provider Details

I. General information

NPI: 1699456814
Provider Name (Legal Business Name): TESIA PATRICE NICHOLS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5048 E 57TH ST STE B
SIOUX FALLS SD
57108-8821
US

IV. Provider business mailing address

5048 E 57TH ST STE B
SIOUX FALLS SD
57108-8821
US

V. Phone/Fax

Practice location:
  • Phone: 605-306-3240
  • Fax: 605-271-3376
Mailing address:
  • Phone: 605-306-3240
  • Fax: 605-271-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6406
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6406
License Number StateSD

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: