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Organization
LAC CASTOR WELLNESS, LLC
Active
Organization
LAC CASTOR WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MELINDA MCCUSKER PHD, CNP (OWNER/FOUNDER)
(605) 415-1616
Entity
Organization
Contact information
Practice address
3213 W MAIN ST, RAPID CITY, SD 57702-2314
(605) 415-1616
Mailing address
3213 W MAIN ST, RAPID CITY, SD 57702-2314
(605) 415-1616
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CP001043
SD
Other
Enumeration date
05/09/2016
Last updated
03/20/2017
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