Provider Demographics
NPI:1891201992
Name:JEFFCOAT, WANDA JO (LPC-MH)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:JO
Last Name:JEFFCOAT
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 S STEVEN CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3008
Mailing Address - Country:US
Mailing Address - Phone:605-201-0509
Mailing Address - Fax:
Practice Address - Street 1:5024 S BUR OAK PL STE 115
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2237
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH30507101YM0800X
SDLPC20248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional