Provider Demographics
NPI:1366694325
Name:RITZMAN, KELLY MARIE (MS, NCC, LPC-MH, RPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:RITZMAN
Suffix:
Gender:F
Credentials:MS, NCC, LPC-MH, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 W 49TH ST STE 204B
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4255
Mailing Address - Country:US
Mailing Address - Phone:605-376-0369
Mailing Address - Fax:605-271-1395
Practice Address - Street 1:3701 W 49TH ST STE 204B
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-4255
Practice Address - Country:US
Practice Address - Phone:605-376-0369
Practice Address - Fax:605-271-1395
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548408198OtherNPI
SD6576590Medicaid
SDLPC-MH2175OtherLICENSED PROFESSIONAL COUNSELOR-MENTAL HEALTH
CAT-1150OtherREGISTERED PLAY THERAPIST
72760OtherNBCC
11921531OtherCAQH