MEDICARE: FIRST STEP COUNSELING, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1780844605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP COUNSELING, INC

Provider Business Mailing Address
First Line	:	4320 S LOUISE AVE
Second Line	:	SUITE 200
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	:	SUITE 200
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3143
Country	:	US
Telephone Number	:	605-361-1505
Fax Number	:	605-361-0481

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LOU ANN SOLEM
Credential	:	CCDC III
Telephone Number	:	605-361-1505

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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