Healthcare Provider Details

I. General information

NPI: 1417680125
Provider Name (Legal Business Name): GOOD KARMA WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 12/25/2023
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 CATHY DR
TEA SD
57064-2199
US

IV. Provider business mailing address

4800 S LOUISE AVE PMB 328
SIOUX FALLS SD
57106-2217
US

V. Phone/Fax

Practice location:
  • Phone: 507-213-6171
  • Fax:
Mailing address:
  • Phone: 605-215-1108
  • 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 TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TRISHA KARSTEN GAUDIG
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 605-215-1108