1932166550 NPI number — MS. ROSWITHA MARIA KONZ MA LPC

Table of content: MS. ROSWITHA MARIA KONZ MA LPC (NPI 1932166550)

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".