Provider Demographics
NPI:1114298247
Name:KOLBREK, CONSTANCE ELISE
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ELISE
Last Name:KOLBREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:ELISE
Other - Last Name:KOLBREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1101 E LIBBY LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4667
Mailing Address - Country:US
Mailing Address - Phone:605-254-5525
Mailing Address - Fax:605-977-2156
Practice Address - Street 1:6901 S LYNCREST PL STE 105
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2574
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:605-731-0896
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC984101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool