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NPI Code Detail

MEDICARE: BOYD A BRISTOW LPC-MH,QMHP,LMFT,MA

MEDICARE: BOYD A BRISTOW LPC-MH,QMHP,LMFT,MA
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 CounselorLPC-MH 2052SD
2106H00000XMarriage & Family TherapistLMFT 1170SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14998932OTHERSDBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457437915
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOYD A BRISTOW LPC-MH,QMHP,LMFT,MA
Provider Business Mailing Address
First Line : 523 N DULUTH AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-2714
Country : US
Telephone Number : 605-988-3775
Fax Number : 605-988-3747
Provider Business Practice Location Address
First Line : 523 N DULUTH AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-2714
Country : US
Telephone Number : 605-988-3775
Fax Number : 605-988-3747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 09/11/2025

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Directions to “ BOYD A BRISTOW LPC-MH,QMHP,LMFT,MA” Practice Location

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