Provider Demographics
NPI:1528289766
Name:CATHOLIC SOCIAL SERVICES
Entity type:Organization
Organization Name:CATHOLIC SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:KINYON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-MH, LMFT
Authorized Official - Phone:605-348-6086
Mailing Address - Street 1:918 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3709
Mailing Address - Country:US
Mailing Address - Phone:605-348-6086
Mailing Address - Fax:605-348-1050
Practice Address - Street 1:918 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3709
Practice Address - Country:US
Practice Address - Phone:605-348-6086
Practice Address - Fax:605-348-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD53001466028078ERA001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4998514Medicare UPIN
SD9211791Medicare UPIN