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General NPI Number Information
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NPI Number | 1841568854
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Entity Type | Organization
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Legal Business Name | POSITIVE DIRECTIONS COUNSELING, INC
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 549 MOUNT RUSHMORE RD STE 1
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City | CUSTER
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State | SD
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Zip | 57730-1531
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Country | US
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Telephone | 605-440-2059
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 382
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City | CUSTER
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State | SD
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Zip | 57730-0382
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Country | US
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Telephone | 605-440-2059
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MS. ROXANNE R DOMEK
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Credential | LPC-MH
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Telephone | 605-440-2059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-MH2193
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License Number State | SD
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