# LAC CASTOR WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962858985
- **Authorized official:** DR. MELINDA MCCUSKER PHD, CNP (OWNER/FOUNDER)
- **Authorized official phone:** (605) 415-1616

## Contact information

- **Practice address:** 3213 W MAIN ST, RAPID CITY, SD 57702-2314
- **Practice address phone:** (605) 415-1616
- **Mailing address:** 3213 W MAIN ST, RAPID CITY, SD 57702-2314
- **Mailing address phone:** (605) 415-1616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | CP001043 | SD | Yes |

## Other

- **Enumeration date:** 05/09/2016
- **Last updated:** 03/20/2017