1013116508 NPI number — VISION QUEST COUNSELING CENTER

Table of content: (NPI 1013116508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013116508 NPI number — VISION QUEST COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION QUEST COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1013116508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
961 1/2 MAIN STREET
Provider Second Line Business Mailing Address:
VISION QUEST COUNSELING CENTER
Provider Business Mailing Address City Name:
STURGIS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57785-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-641-1843
Provider Business Mailing Address Fax Number:
605-716-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
961 1/2 MAIN ST
Provider Second Line Business Practice Location Address:
VISION QUEST COUNSELING CENTER
Provider Business Practice Location Address City Name:
STURGIS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57785-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-641-1843
Provider Business Practice Location Address Fax Number:
605-716-1002
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POWERS
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MENTAL HEALTH THERAPIST
Authorized Official Telephone Number:
605-641-1843

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LPC7006 , 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)





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