MEDICARE: LIFESTANCE HEALTH - SOUTH DAKOTA, P.C. DBA LIFESTANCE HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	103T00000X	Psychologist
5	106H00000X	Marriage & Family Therapist
6	103TC0700X	Clinical Psychologist
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	104100000X	Social Worker
9	1041C0700X	Clinical Social Worker
10	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician

General Provider Information

NPI Number	:	1245161116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTANCE HEALTH - SOUTH DAKOTA, P.C. DBA LIFESTANCE HEALTH

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S REID ST STE 307
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-7045
Country	:	US
Telephone Number	:	253-346-0399
Fax Number	:

Authorized Official
Title or Position	:	CHIEF LEGAL OFFICER
Name	:	RYAN PARDO
Credential	:
Telephone Number	:	425-279-8500

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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