Provider Demographics
NPI:1336385558
Name:MCKEOWN, KRISTA A (MA LMFT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:A
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S LYNCREST PL STE 105
Mailing Address - Street 2:WELLSPRING THERAPY CENTER
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2574
Mailing Address - Country:US
Mailing Address - Phone:605-335-1516
Mailing Address - Fax:
Practice Address - Street 1:4301 W 57TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2255
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:605-731-0896
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT1223106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200060Medicaid