Provider Demographics
NPI:1568548048
Name:CURRAN, MARY CAROLE (PHD, ABPP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLE
Last Name:CURRAN
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N DULUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-2714
Mailing Address - Country:US
Mailing Address - Phone:605-988-3775
Mailing Address - Fax:605-988-3747
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:605-988-3747
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD118103TC0700X
SDLMFT 1012106H00000X
MNLMFT 212106H00000X
COLMFT 140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE460275690-26Medicaid
CO07015506Medicaid
SD6550092Medicaid
NE460275690-26Medicaid
SD6099Medicare ID - Type Unspecified