MEDICARE: LESLEY ANNE DZINTARS 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	2103	SD

General Provider Information

NPI Number	:	1114102068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY ANNE DZINTARS LPC-MH, QMHP

Provider Business Mailing Address
First Line	:	2640 JACKSON BLVD STE 7
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3400
Country	:	US
Telephone Number	:	605-341-8647
Fax Number	:	605-341-0489

Provider Business Practice Location Address
First Line	:	2640 JACKSON BLVD STE 7
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-3400
Country	:	US
Telephone Number	:	605-341-8647
Fax Number	:	605-341-0489

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	11/09/2025

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