Healthcare Provider Details

I. General information

NPI: 1699346924
Provider Name (Legal Business Name): FIREFLY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 WILLOW CREEK DR STE 2B
WATERTOWN SD
57201-9150
US

IV. Provider business mailing address

2028 LANOUE CIR
WATERTOWN SD
57201-5513
US

V. Phone/Fax

Practice location:
  • Phone: 605-878-0376
  • Fax:
Mailing address:
  • Phone: 605-237-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE HENDRICKS
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 605-237-3717