Provider Demographics
NPI:1093283632
Name:GHOST, BERLYN
Entity Type:Individual
Prefix:
First Name:BERLYN
Middle Name:
Last Name:GHOST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ELK ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7351
Mailing Address - Country:US
Mailing Address - Phone:605-343-7262
Mailing Address - Fax:605-343-7293
Practice Address - Street 1:3 CANYON VIEW CIR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1700
Practice Address - Country:US
Practice Address - Phone:605-745-6222
Practice Address - Fax:605-745-4930
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health