Provider Demographics
NPI:1700247681
Name:NEUCOM, DANETTE (MA)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:
Last Name:NEUCOM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:
Other - Last Name:CAVENDER OR CREAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2601 S MINNESOTA AVE STE 105
Mailing Address - Street 2:PMB 304
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:720-840-6021
Mailing Address - Fax:
Practice Address - Street 1:5024 S BUR OAK PL STE 206
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2238
Practice Address - Country:US
Practice Address - Phone:605-971-7136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60610560101Y00000X
WALH60805877103TC1900X
SDLPC-MH30667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling