Healthcare Provider Details

I. General information

NPI: 1629909924
Provider Name (Legal Business Name): EMBER AND BLOOM ART THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 69TH ST STE 210
SIOUX FALLS SD
57108-8586
US

IV. Provider business mailing address

1601 E 69TH ST STE 210
SIOUX FALLS SD
57108-8586
US

V. Phone/Fax

Practice location:
  • Phone: 605-215-1108
  • Fax:
Mailing address:
  • Phone: 605-215-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELLE GUNDERMANN
Title or Position: OWNER/MANAGER/CLINICIAN
Credential: LPC-MH
Phone: 605-215-1108