Provider Demographics
NPI:1801569538
Name:NORTHERN HILLS COUNSELING ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHERN HILLS COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREN-CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-MH, QMHP
Authorized Official - Phone:605-641-7534
Mailing Address - Street 1:211 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2646
Mailing Address - Country:US
Mailing Address - Phone:605-641-7534
Mailing Address - Fax:605-559-0243
Practice Address - Street 1:211 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2646
Practice Address - Country:US
Practice Address - Phone:605-641-7534
Practice Address - Fax:605-559-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty