Provider Demographics
NPI:1760657308
Name:OLTHOFF, LUANNA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:LUANNA
Middle Name:LYNN
Last Name:OLTHOFF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2569
Mailing Address - Country:US
Mailing Address - Phone:605-838-9655
Mailing Address - Fax:605-271-2548
Practice Address - Street 1:6809 S MINNESOTA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2569
Practice Address - Country:US
Practice Address - Phone:605-838-9655
Practice Address - Fax:605-271-2548
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
QMHP101Y00000X
SDLPCMH2061101YM0800X
SDLAC9707970101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)