Provider Demographics
NPI:1538101043
Name:SPIVEY, ELIZABETH SUMNER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SUMNER
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIZ
Other - Middle Name:SUMNER
Other - Last Name:SPIVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:121 W 3RD SUITE 203
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-668-2222
Mailing Address - Fax:605-668-2222
Practice Address - Street 1:121 W 3RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-668-2222
Practice Address - Fax:605-668-2222
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040573OtherBLUE CROSS BLUE SHIELD
SD9204887OtherDAKOTACARE
41302Medicare ID - Type Unspecified
SD6551922Medicare ID - Type Unspecified