Provider Demographics
NPI:1215918339
Name:LEWIS & CLARK BEHAVIORAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:LEWIS & CLARK BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOXENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-4606
Mailing Address - Street 1:1028 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2910
Mailing Address - Country:US
Mailing Address - Phone:605-665-4606
Mailing Address - Fax:605-665-4673
Practice Address - Street 1:1028 WALNUT ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2910
Practice Address - Country:US
Practice Address - Phone:605-665-4606
Practice Address - Fax:605-665-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200050Medicaid
0069993OtherBCBS
SD5200050Medicaid