MEDICARE: FIRST STEP COUNSELING SERVICES INC.

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	251S00000X	Community/Behavioral Health Agency		SD

General Provider Information

NPI Number	:	1720388556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP COUNSELING SERVICES INC.

Provider Business Mailing Address
First Line	:	4320 S LOUISE AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3143
Country	:	US
Telephone Number	:	605-361-1505
Fax Number	:	605-361-0481

Provider Business Practice Location Address
First Line	:	4320 S LOUISE AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3143
Country	:	US
Telephone Number	:	605-361-1505
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MRS. LOU ANN TIETJEN
Credential	:	CCDC III
Telephone Number	:	605-361-1505

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	06/15/2011

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