Provider Demographics
NPI:1154816841
Name:SATTERWHITE, BRYAN M (MSW, CSW, PIP, QMHP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:SATTERWHITE
Suffix:
Gender:M
Credentials:MSW, CSW, PIP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 E ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:SD
Mailing Address - Zip Code:57718-9768
Mailing Address - Country:US
Mailing Address - Phone:605-430-1913
Mailing Address - Fax:
Practice Address - Street 1:4733 E ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:BLACK HAWK
Practice Address - State:SD
Practice Address - Zip Code:57718-9768
Practice Address - Country:US
Practice Address - Phone:605-430-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD61211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical