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NPI Code Detail

MEDICARE: MRS. RACHEL PETTERSEN LPC-MH, QMHP

MEDICARE:  MRS. RACHEL  PETTERSEN  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
1101YM0800XMental Health CounselorLPCMH20297SD
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114357134
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RACHEL PETTERSEN LPC-MH, QMHP
Provider Business Mailing Address
First Line : 115 N 7TH ST STE 4
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2710
Country : US
Telephone Number : 605-641-2661
Fax Number : 605-644-5121
Provider Business Practice Location Address
First Line : 115 N 7TH ST STE 4
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2710
Country : US
Telephone Number : 605-641-2661
Fax Number : 605-644-5121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2013
Last Update Date : 06/12/2024

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Directions to “ MRS. RACHEL PETTERSEN LPC-MH, QMHP” Practice Location

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