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General NPI Number Information
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NPI Number | 1518769421
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Entity Type | Organization
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Legal Business Name | LITTLE WILDFLOWER PLAY THERAPY, LLC
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 630 6TH AVE
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City | BROOKINGS
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State | SD
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Zip | 57006-1431
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Country | US
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Telephone | 605-491-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 630 6TH AVE
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City | BROOKINGS
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State | SD
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Zip | 57006-1431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICIAN
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Name | BROOKE RUSTMAN
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Credential | LPC, RPT
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Telephone | 605-491-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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