Provider Demographics
NPI:1740604099
Name:BACH, MAHALA (LPC, QMHP)
Entity Type:Individual
Prefix:
First Name:MAHALA
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:LPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 N LACROSSE ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6976
Mailing Address - Country:US
Mailing Address - Phone:605-431-4106
Mailing Address - Fax:
Practice Address - Street 1:1575 N LACROSSE ST
Practice Address - Street 2:SUITE H
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6976
Practice Address - Country:US
Practice Address - Phone:605-431-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor