Provider Demographics
NPI:1790709145
Name:PSYCHOLOGICAL EVALUATION THERAPY & RESEARCH LTD
Entity Type:Organization
Organization Name:PSYCHOLOGICAL EVALUATION THERAPY & RESEARCH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:605-341-8647
Mailing Address - Street 1:3601 CANYON LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-341-8647
Mailing Address - Fax:605-341-0489
Practice Address - Street 1:3601 CANYON LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-341-8647
Practice Address - Fax:605-341-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD123103T00000X, 103TA0400X, 103TC0700X, 103TF0000X, 103TF0200X, 103TM1800X, 103TR0400X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty