MEDICARE: KRISTA A. MCKEOWN M.A. LMFT

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	106H00000X	Marriage & Family Therapist	LMFT1223	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336385558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA A. MCKEOWN M.A. LMFT

Provider Business Mailing Address
First Line	:	6901 S LYNCREST PL STE 105
Second Line	:	WELLSPRING THERAPY CENTER
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2574
Country	:	US
Telephone Number	:	605-335-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 W 57TH ST STE 100
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2255
Country	:	US
Telephone Number	:	605-335-1516
Fax Number	:	605-731-0896

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

Provider Enumeration Date	:	12/17/2008
Last Update Date	:	05/07/2024

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