MEDICARE: KELLY MARIE RITZMAN MS, NCC, LPC-MH, RPT

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-MH2175	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548408198	OTHER		NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	LPC-MH2175	OTHER	SD	LICENSED PROFESSIONAL COUNSELOR-MENTAL HEALTH
4	T-1150	OTHER	CA	REGISTERED PLAY THERAPIST
5	72760	OTHER		NBCC
6	11921531	OTHER		CAQH

General Provider Information

NPI Number	:	1366694325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE RITZMAN MS, NCC, LPC-MH, RPT

Provider Business Mailing Address
First Line	:	3701 W 49TH ST STE 204B
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4255
Country	:	US
Telephone Number	:	605-376-0369
Fax Number	:	605-271-1395

Provider Business Practice Location Address
First Line	:	3701 W 49TH ST STE 204B
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4255
Country	:	US
Telephone Number	:	605-376-0369
Fax Number	:	605-271-1395

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	07/27/2021

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