Provider Demographics
NPI:1275265761
Name:KRIS JEAKINS, LLC
Entity Type:Organization
Organization Name:KRIS JEAKINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:605-430-4214
Mailing Address - Street 1:109 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-9620
Mailing Address - Country:US
Mailing Address - Phone:605-430-4214
Mailing Address - Fax:
Practice Address - Street 1:3618 CANYON LAKE DR STE 107
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3129
Practice Address - Country:US
Practice Address - Phone:605-430-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty