Provider Demographics
NPI:1457879710
Name:WOLTHUIZEN, ADAM JOHN (MS, LPC-MH, NCC,QMHP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:WOLTHUIZEN
Suffix:
Gender:M
Credentials:MS, LPC-MH, NCC,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 S KIWANIS CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4266
Mailing Address - Country:US
Mailing Address - Phone:605-663-4600
Mailing Address - Fax:605-663-4663
Practice Address - Street 1:3805 S KIWANIS CIR STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4266
Practice Address - Country:US
Practice Address - Phone:605-663-4600
Practice Address - Fax:605-663-4663
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH20391101YM0800X
SDLPC20348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional