Healthcare Provider Details

I. General information

NPI: 1750285532
Provider Name (Legal Business Name): PUPAZEEYA COOK LCSW, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

1221 S FOSS AVE
SIOUX FALLS SD
57110-8517
US

IV. Provider business mailing address

1221 S FOSS AVE
SIOUX FALLS SD
57110-8517
US

V. Phone/Fax

Practice location:
  • Phone: 605-709-3308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1903
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4933
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4933
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: