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General NPI Number Information
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NPI Number | 1477359578
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Entity Type | Organization
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Legal Business Name | YOUTH HEALING CIRCLE
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 505 ASH ST
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City | SUMMIT
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State | SD
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Zip | 57266-2115
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Country | US
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Telephone | 605-237-1006
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Fax | 605-398-5337
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Provider Business Mailing Address
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Address Line | PO BOX 802
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City | SUMMIT
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State | SD
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Zip | 57266-0802
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Country | US
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Telephone | 605-237-1006
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Fax |
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Authorized Official
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Title or Position | OWNER / COUNSELOR
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Name | TERESA KAY WHITE
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Credential | LAC
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Telephone | 605-268-4306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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