Provider Demographics
NPI:1700192200
Name:GARRY PSYCHIATRIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GARRY PSYCHIATRIC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-877-1324
Mailing Address - Street 1:636 SAINT ANNE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4694
Mailing Address - Country:US
Mailing Address - Phone:605-721-8822
Mailing Address - Fax:
Practice Address - Street 1:636 SAINT ANNE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4694
Practice Address - Country:US
Practice Address - Phone:605-721-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD50022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDG43072Medicare UPIN