Provider Demographics
NPI:1992707509
Name:DONALDSON, DELTRON C (D MIN LMFT)
Entity type:Individual
Prefix:DR
First Name:DELTRON
Middle Name:C
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:D MIN LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1552
Mailing Address - Country:US
Mailing Address - Phone:605-334-2696
Mailing Address - Fax:605-339-9944
Practice Address - Street 1:1410 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1552
Practice Address - Country:US
Practice Address - Phone:605-334-2696
Practice Address - Fax:605-339-9944
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30G61D0OtherBCBS
218521034045OtherPREFERRED ONE
218521034045OtherPREFERRED ONE