Provider Demographics
NPI:1609346006
Name:JEAKINS, KRIS (MS, NCC, LPC-MH)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:JEAKINS
Suffix:
Gender:F
Credentials:MS, NCC, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-9620
Mailing Address - Country:US
Mailing Address - Phone:605-430-4214
Mailing Address - Fax:
Practice Address - Street 1:520 KANSAS CITY ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5005
Practice Address - Country:US
Practice Address - Phone:605-299-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30526101YM0800X
SDLPC20247101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor