Provider Demographics
NPI:1396513974
Name:JEFFCOAT COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:JEFFCOAT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JEFFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MH, QMHP
Authorized Official - Phone:605-610-9156
Mailing Address - Street 1:5024 S BUR OAK PL STE 115
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2237
Mailing Address - Country:US
Mailing Address - Phone:605-610-9156
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:605-610-9156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty