Provider Demographics
NPI:1396805297
Name:PSYCHOLOGICAL ASSOCIATES OF YANKTON, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF YANKTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:VAN GILDER-PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-0258
Mailing Address - Street 1:2703 FOX RUN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5382
Mailing Address - Country:US
Mailing Address - Phone:605-665-0258
Mailing Address - Fax:605-665-2707
Practice Address - Street 1:2703 FOX RUN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5382
Practice Address - Country:US
Practice Address - Phone:605-665-0258
Practice Address - Fax:605-665-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1396805297Medicaid