Provider Demographics
NPI:1205999315
Name:BLACK HILLS COUNSELING LLC
Entity type:Organization
Organization Name:BLACK HILLS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKRAAI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MH
Authorized Official - Phone:605-720-8090
Mailing Address - Street 1:1238 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1540
Mailing Address - Country:US
Mailing Address - Phone:605-720-8090
Mailing Address - Fax:605-720-8090
Practice Address - Street 1:1238 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1540
Practice Address - Country:US
Practice Address - Phone:605-720-8090
Practice Address - Fax:605-720-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1002553Medicaid