Provider Demographics
NPI:1255671228
Name:LEMMERT, CORY
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:LEMMERT
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 1:500 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2604
Mailing Address - Country:US
Mailing Address - Phone:605-842-1465
Mailing Address - Fax:
Practice Address - Street 1:500 E 9TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2604
Practice Address - Country:US
Practice Address - Phone:605-842-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health