Provider Demographics
NPI:1720351976
Name:VELGERSDYK, NICOLE MARIE (MS, LPC, NCC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:VELGERSDYK
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2727
Mailing Address - Country:US
Mailing Address - Phone:605-336-0510
Mailing Address - Fax:
Practice Address - Street 1:3240 E BISON TRL STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8006
Practice Address - Country:US
Practice Address - Phone:605-961-4746
Practice Address - Fax:605-961-4647
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7209101YM0800X
SDLPC-MH2248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health