Provider Demographics
NPI:1063151629
Name:SIOUXLAND CHILD & ADOLESCENT THERAPY SERVICES
Entity type:Organization
Organization Name:SIOUXLAND CHILD & ADOLESCENT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:605-271-7117
Mailing Address - Street 1:707 S TAYBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-7739
Mailing Address - Country:US
Mailing Address - Phone:605-359-1180
Mailing Address - Fax:
Practice Address - Street 1:3700 S KIWANIS AVE STE 4
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4294
Practice Address - Country:US
Practice Address - Phone:605-271-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty