MEDICARE: MRS. TERESA M HENRICKSON LPC MH

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	9607791	SD
2	101YP2500X	Professional Counselor	LPC-MH2127	SD
3	101YM0800X	Mental Health Counselor	LPCMH2127

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4994223	OTHER	BLUE CROSS
3	20630	OTHER	SIOUX VALLEY HEALTH PLAN
4	246780	OTHER	MIDLANDS CHOICE
5	9235337	OTHER	DAKOTA CARE
6	235666	OTHER	COMPSYCH

NPI Number	:	1518029917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA M HENRICKSON LPC MH

Provider Business Mailing Address
First Line	:	904 W 23RD ST STE 101
Second Line	:	HEARTLAND PSYCHOLOGICAL SERVICES
City	:	YANKTON
State	:	SD
Zip	:	57078
Country	:	US
Telephone Number	:	605-665-0841
Fax Number	:	605-665-0096

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	:	605-988-3875

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	03/20/2024

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: