Provider Demographics
NPI:1407949084
Name:PAIN SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PAIN SOLUTIONS, LLC
Other - Org Name:LIFE WITHOUT BOUNDARIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CHAMBERLAIN
Authorized Official - Last Name:HAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MH, QMHP
Authorized Official - Phone:605-737-0769
Mailing Address - Street 1:2404 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3450
Mailing Address - Country:US
Mailing Address - Phone:605-737-0769
Mailing Address - Fax:605-721-1196
Practice Address - Street 1:2404 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3450
Practice Address - Country:US
Practice Address - Phone:605-737-0769
Practice Address - Fax:605-721-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD LPC-MH 2081101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575560Medicaid