Provider Demographics
NPI:1760855860
Name:FOUR DIRECTIONS COUNSELING, INC.
Entity Type:Organization
Organization Name:FOUR DIRECTIONS COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:605-359-5709
Mailing Address - Street 1:315 N MAIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6077
Mailing Address - Country:US
Mailing Address - Phone:605-359-5709
Mailing Address - Fax:
Practice Address - Street 1:315 N MAIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6077
Practice Address - Country:US
Practice Address - Phone:605-359-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health