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General NPI Number Information
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NPI Number | 1720074644
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Entity Type | Organization
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Legal Business Name | HUMAN SERVICE AGENCY
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 123 19TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-2823
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Country | US
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Telephone | 605-886-0123
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Fax | 605-886-5447
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Provider Business Mailing Address
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Address Line | 123 19TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-2823
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Country | US
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Telephone | 605-886-0123
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Fax | 605-886-5447
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Authorized Official
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Title or Position | CEO
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Name | DR. KARI JOHNSTON
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Credential | LPC-MH
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Telephone | 605-886-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 704
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 006
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 006
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 704
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License Number State | SD
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 006
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License Number State | SD
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Taxonomy #6
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 704
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License Number State | SD
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Taxonomy #7
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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 | 006
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License Number State | SD
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Taxonomy #8
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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 | 704
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License Number State | SD
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Taxonomy #9
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 006
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License Number State | SD
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Taxonomy #10
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 704
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License Number State | SD
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Taxonomy #11
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 006
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License Number State | SD
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Taxonomy #12
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 704
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License Number State | SD
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