Provider Demographics
NPI:1457720476
Name:THE SUPPORT CIRCLE, INC
Entity Type:Organization
Organization Name:THE SUPPORT CIRCLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO, & THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HAEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCMH
Authorized Official - Phone:605-845-2058
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-0684
Mailing Address - Country:US
Mailing Address - Phone:605-845-2058
Mailing Address - Fax:605-845-2062
Practice Address - Street 1:321 2ND AVE E
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-2617
Practice Address - Country:US
Practice Address - Phone:605-845-2058
Practice Address - Fax:606-845-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND695-8-1-11-245251S00000X
SDLPCMH2303251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health