Provider Demographics
NPI:1558751933
Name:BLOCK, KEITH B (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:B
Last Name:BLOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0900
Mailing Address - Country:US
Mailing Address - Phone:605-336-2140
Mailing Address - Fax:605-336-1677
Practice Address - Street 1:6215 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8596
Practice Address - Country:US
Practice Address - Phone:605-322-3300
Practice Address - Fax:605-322-3301
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD52511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3033OtherLICENSE