Provider Demographics
NPI:1295933786
Name:DAKOTA PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:DAKOTA PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:605-334-4549
Mailing Address - Street 1:707 E 41ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6049
Mailing Address - Country:US
Mailing Address - Phone:605-334-4549
Mailing Address - Fax:605-334-4549
Practice Address - Street 1:707 E 41ST ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6049
Practice Address - Country:US
Practice Address - Phone:605-334-4549
Practice Address - Fax:605-334-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD356251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1750442752OtherNPI
SD6551155Medicaid