Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | LPCMH2127 | |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 09607791 | SD |
NPI | 1518029917 |
---|---|
Provider Name | Mrs. Teresa M Henrickson |
First Address | Yankton, SD 57078 |
Second Address | Yankton, SD 57078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20630 | SIOUX VALLEY HEALTH PLAN (01) | |
235666 | COMPSYCH (01) | |
246780 | MIDLANDS CHOICE (01) | |
4994223 | BLUE CROSS (01) | |
6576050 | (05) | SD |
9235337 | DAKOTA CARE (01) |