Provider Demographics
NPI:1497204937
Name:DENT, MOLLY DRIEL (EDS, SCHOOL PSYCHO)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DRIEL
Last Name:DENT
Suffix:
Gender:F
Credentials:EDS, SCHOOL PSYCHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39504 STATE SPUR 16B
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201
Mailing Address - Country:US
Mailing Address - Phone:402-322-1705
Mailing Address - Fax:
Practice Address - Street 1:102 E. DENVER DRIVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555
Practice Address - Country:US
Practice Address - Phone:605-856-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD71425-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist