Provider Demographics
NPI:1518581883
Name:MICHELLE WENGE COUNSELING THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MICHELLE WENGE COUNSELING THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WENGE
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:605-777-4033
Mailing Address - Street 1:5024 S BUR OAK PL STE 208
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2238
Mailing Address - Country:US
Mailing Address - Phone:605-274-3333
Mailing Address - Fax:605-274-3111
Practice Address - Street 1:5024 S BUR OAK PL STE 208
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2238
Practice Address - Country:US
Practice Address - Phone:605-274-3333
Practice Address - Fax:605-274-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4769OtherSOCIAL WORKER EXAMINERS FOR THE STATE OF SD