Provider Demographics
NPI:1316396849
Name:SHOUP ANDERSON, BARBARA (MA, LAC, NCC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:SHOUP ANDERSON
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:FORT PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532-0128
Mailing Address - Country:US
Mailing Address - Phone:605-223-9716
Mailing Address - Fax:
Practice Address - Street 1:110 W MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4506
Practice Address - Country:US
Practice Address - Phone:605-222-3841
Practice Address - Fax:605-734-8070
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD98111026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)