Provider Demographics
NPI:1053313098
Name:BOEHM-SHERECK, LURENE (LPC MH)
Entity Type:Individual
Prefix:MRS
First Name:LURENE
Middle Name:
Last Name:BOEHM-SHERECK
Suffix:
Gender:F
Credentials:LPC MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BETHESDA CHRISTIAN COUNSELING MIDWEST INC
Mailing Address - Street 2:400 S SYCAMORE AVE SUITE 105-3
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-1255
Mailing Address - Country:US
Mailing Address - Phone:605-334-3739
Mailing Address - Fax:605-334-7752
Practice Address - Street 1:BETHESDA CHRISTIAN COUNSELING MIDWEST INC
Practice Address - Street 2:400 S SYCAMORE AVE SUITE 105-3
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-1255
Practice Address - Country:US
Practice Address - Phone:605-334-3739
Practice Address - Fax:605-334-7752
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2093101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575650Medicaid