Healthcare Provider Details

I. General information

NPI: 1477359578
Provider Name (Legal Business Name): YOUTH HEALING CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 ASH ST
SUMMIT SD
57266-2115
US

IV. Provider business mailing address

PO BOX 802
SUMMIT SD
57266-0802
US

V. Phone/Fax

Practice location:
  • Phone: 605-237-1006
  • Fax: 605-398-5337
Mailing address:
  • Phone: 605-237-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA KAY WHITE
Title or Position: OWNER / COUNSELOR
Credential: LAC
Phone: 605-268-4306