Provider Demographics
NPI:1982251252
Name:RAPID CITY MENTAL HEALTH PROF. LLC
Entity Type:Organization
Organization Name:RAPID CITY MENTAL HEALTH PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ERDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-716-3555
Mailing Address - Street 1:3939 CANYON LAKE DR STE A
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0827
Mailing Address - Country:US
Mailing Address - Phone:605-716-3555
Mailing Address - Fax:605-413-1143
Practice Address - Street 1:3939 CANYON LAKE DR STE A
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0827
Practice Address - Country:US
Practice Address - Phone:605-716-3555
Practice Address - Fax:605-413-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty