1932166550 NPI number — MS. ROSWITHA MARIA KONZ MA LPC

Table of content: (NPI 1710180732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932166550 NPI number — MS. ROSWITHA MARIA KONZ MA LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONZ
Provider First Name:
ROSWITHA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932166550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 W HAVENS ST
Provider Second Line Business Mailing Address:
DAKOTA COUNSELING INSTITUTE
Provider Business Mailing Address City Name:
MITCHELL
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-996-9686
Provider Business Mailing Address Fax Number:
605-996-1624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 W HAVENS ST
Provider Second Line Business Practice Location Address:
DAKOTA COUNSELING INSTITUTE
Provider Business Practice Location Address City Name:
MITCHELL
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-996-9686
Provider Business Practice Location Address Fax Number:
605-996-1624
Provider Enumeration Date:
04/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC734 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6184 . This is a "AVERA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21087 . This is a "SIOUX VALLEY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4997191 . This is a "WELLMARK BCBS" identifier . This identifiers is of the category "OTHER".