Provider Demographics
NPI:1417521543
Name:ADAM WOLTHUIZEN COUNSELING, LLC
Entity Type:Organization
Organization Name:ADAM WOLTHUIZEN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WOLTHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MH, NCC,QMHP
Authorized Official - Phone:605-663-4600
Mailing Address - Street 1:3805 S KIWANIS CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4266
Mailing Address - Country:US
Mailing Address - Phone:605-663-4600
Mailing Address - Fax:605-663-4663
Practice Address - Street 1:3805 S KIWANIS CIR STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4266
Practice Address - Country:US
Practice Address - Phone:605-663-4600
Practice Address - Fax:605-663-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty