Provider Demographics
NPI:1811001985
Name:THREE RIVERS MENTAL HEALTH AND CHEMICAL DEPENDENCY CENTER
Entity Type:Organization
Organization Name:THREE RIVERS MENTAL HEALTH AND CHEMICAL DEPENDENCY CENTER
Other - Org Name:THREE RIVERS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-374-3862
Mailing Address - Street 1:11 EAST 4TH ST.
Mailing Address - Street 2:P.O. BOX 447
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-0447
Mailing Address - Country:US
Mailing Address - Phone:605-374-3862
Mailing Address - Fax:605-374-3864
Practice Address - Street 1:11 EAST 4TH STREET
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57638-0447
Practice Address - Country:US
Practice Address - Phone:605-374-3862
Practice Address - Fax:605-374-3864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1162101YM0800X
SD1082101YM0800X
SDLPC1098101YM0800X
SD1948101YM0800X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0003226OtherBCBS GROUP PROVIDER #
SD1234567OtherJASON LILLICH
SD4994184OtherMIKKI KENNEDY-HAINES ID#
SD4995756OtherANGELA PEDRETTI BCBS ID#
SD4996764OtherALLAN MCGOUGH BCBS ID#
SD4995756OtherANGELA PEDRETTI BCBS ID#