Provider Demographics
NPI:1043984727
Name:2DEGREECHANGE LLC
Entity Type:Organization
Organization Name:2DEGREECHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:605-595-1583
Mailing Address - Street 1:47352 299TH ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-6733
Mailing Address - Country:US
Mailing Address - Phone:605-595-1583
Mailing Address - Fax:
Practice Address - Street 1:4301 W 57TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2255
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty