Individual
DR. DEWEY J. ERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
3601 CANYON LAKE DR, RAPID CITY, SD 57702-3900
(605) 341-8647
(605) 341-0489
Mailing address
3601 CANYON LAKE DR, RAPID CITY, SD 57702-3900
(605) 341-8647
(605) 341-0489
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
123
SD
103T00000X
Psychologist
Primary
123
SD
103TC0700X
Clinical Psychologist
123
SD
103TF0000X
Family Psychologist
123
SD
103TF0200X
Forensic Psychologist
123
SD
103TM1800X
Intellectual & Developmental Disabilities Psychologist
123
SD
103TP2701X
Group Psychotherapy Psychologist
123
SD
103TR0400X
Rehabilitation Psychologist
123
SD
103TS0200X
School Psychologist
29664-02
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460461452-26
—
NE
05
—
6550193
—
SD
Enumeration date
12/20/2007
Last updated
12/20/2007
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