MEDICARE: SPIRALS COUNSELING, LLC

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	LMFT1209	SD

General Provider Information

NPI Number	:	1538606801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRALS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	623 QUINCY ST STE 102
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8230
Country	:	US
Telephone Number	:	605-381-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 QUINCY ST STE 102
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8230
Country	:	US
Telephone Number	:	605-381-5277
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LYNELL MAR RICE BRINKWORTH
Credential	:	MA, LMFT
Telephone Number	:	605-381-5277

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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