Healthcare Provider Details

I. General information

NPI: 1891918033
Provider Name (Legal Business Name): EGGLESTON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 69TH ST STE 101
SIOUX FALLS SD
57108-8322
US

IV. Provider business mailing address

1601 E 69TH ST STE 101
SIOUX FALLS SD
57108-8322
US

V. Phone/Fax

Practice location:
  • Phone: 605-610-6355
  • Fax:
Mailing address:
  • Phone: 605-610-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC537
License Number StateSD

VIII. Authorized Official

Name: MARY J EGGLESTON
Title or Position: PRESIDENT
Credential: M.S.ED.
Phone: 605-610-6355