Provider Demographics
NPI:1518029917
Name:HENRICKSON, TERESA M (LPC MH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:HENRICKSON
Suffix:
Gender:F
Credentials:LPC MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 23RD ST STE 101
Mailing Address - Street 2:HEARTLAND PSYCHOLOGICAL SERVICES
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:523 N DULUTH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2714
Practice Address - Country:US
Practice Address - Phone:605-988-3775
Practice Address - Fax:605-988-3875
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9607791101YA0400X
SDLPC-MH2127101YP2500X
LPCMH2127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6576050Medicaid
4994223OtherBLUE CROSS
20630OtherSIOUX VALLEY HEALTH PLAN
246780OtherMIDLANDS CHOICE
9235337OtherDAKOTA CARE
235666OtherCOMPSYCH