Provider Demographics
NPI:1073676631
Name:MAYRAND-STERNHAGEN, MARY C (LPC MH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:MAYRAND-STERNHAGEN
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:HEARTLAND PSYCHOLOGICAL SERVICES
Mailing Address - Street 2:904 W 23RD ST STE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:HEARTLAND PSYCHOLOGICAL SERVICES
Practice Address - Street 2:904 W 23RD ST STE 101
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
23088OtherSIOUX VALLEY HEALTH PLAN
4994599OtherBLUE CROSS
SD6575780Medicaid
7771OtherAVERA HEALTH PLAN
232834OtherMIDLANDS CHOICE