Provider Demographics
NPI:1306310065
Name:SIOUX RIVER MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SIOUX RIVER MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MH, LAC, QMH
Authorized Official - Phone:605-413-6957
Mailing Address - Street 1:431 N PHILLIPS AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5933
Mailing Address - Country:US
Mailing Address - Phone:605-413-6957
Mailing Address - Fax:
Practice Address - Street 1:431 N PHILLIPS AVE STE 340
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5933
Practice Address - Country:US
Practice Address - Phone:605-413-6957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD833124997OtherBLUE CROSS/BLUE SHIELD