Provider Demographics
NPI:1770593030
Name:NILLS, SHAWN EARL (MS, NBCC, LPC,QMHP)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:EARL
Last Name:NILLS
Suffix:
Gender:M
Credentials:MS, NBCC, LPC,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2435
Mailing Address - Country:US
Mailing Address - Phone:605-256-9656
Mailing Address - Fax:605-256-2891
Practice Address - Street 1:914 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2435
Practice Address - Country:US
Practice Address - Phone:605-256-9656
Practice Address - Fax:605-256-2891
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC 972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health