Provider Demographics
NPI:1619175783
Name:DOUD, ALICE PEARL (LPC-MH)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:PEARL
Last Name:DOUD
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:PEARL
Other - Last Name:KIDDOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MH
Mailing Address - Street 1:1612 JUNCTION AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2166
Mailing Address - Country:US
Mailing Address - Phone:605-720-8661
Mailing Address - Fax:605-250-0077
Practice Address - Street 1:1612 JUNCTION AVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2166
Practice Address - Country:US
Practice Address - Phone:605-720-8661
Practice Address - Fax:605-250-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH 2304101YM0800X
SD7240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC-MH 2304OtherDEPT. OF SOCIAL SERVICES- BOARD OF EXAMINERS FOR COUNSELORS AND MARRIAGE AND FAM
SD6578410Medicaid