Provider Demographics
NPI:1710462668
Name:BOOZE, WILLETTE S (LPC)
Entity Type:Individual
Prefix:
First Name:WILLETTE
Middle Name:S
Last Name:BOOZE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WILLETTE
Other - Middle Name:S
Other - Last Name:RYERSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2876
Mailing Address - Fax:605-622-2804
Practice Address - Street 1:201 S LLOYD ST STE E201
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4509
Practice Address - Country:US
Practice Address - Phone:605-622-2545
Practice Address - Fax:605-229-2531
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor