Individual
WAKIYAN PETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
24276 166TH ST, EAGLE BUTTE, SD 57625-8141
(605) 964-0722
(605) 964-8905
Mailing address
PO BOX 83, LANTRY, SD 57636-0083
(605) 200-5052
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7051316
SD
Other
Enumeration date
09/29/2023
Last updated
09/29/2023
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