MEDICARE: MS. SUSAN CHAMBERLAIN HAYMAN MS LPC-MH QMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-MH 2081	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4997001	OTHER	SD	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104890144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN CHAMBERLAIN HAYMAN MS LPC-MH QMHP

Provider Business Mailing Address
First Line	:	3405 LELAND LN
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3459
Country	:	US
Telephone Number	:	605-737-0769
Fax Number	:	605-721-1196

Provider Business Practice Location Address
First Line	:	2404 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3450
Country	:	US
Telephone Number	:	605-737-0769
Fax Number	:	605-721-1196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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