Provider Demographics
NPI:1215771449
Name:YOUR COUNSELOR, LLC
Entity type:Organization
Organization Name:YOUR COUNSELOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-SUPERVISEE
Authorized Official - Phone:605-939-1821
Mailing Address - Street 1:105 GIANTS DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8737
Mailing Address - Country:US
Mailing Address - Phone:605-939-1821
Mailing Address - Fax:
Practice Address - Street 1:4447 S CANYON RD STE 6
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-1889
Practice Address - Country:US
Practice Address - Phone:605-939-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty