Individual
GYPSY PETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1218 BLUEBELL LN, CUSTER, SD 57730-2455
(605) 920-1032
Mailing address
1218 BLUEBELL LN, CUSTER, SD 57730-2455
(605) 920-1032
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1464
WY
101YP2500X
Professional Counselor
LPC20921
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1464
LPC
WY
01
—
LPC20921
BOARD OF COUNSELORS
SD
Enumeration date
03/18/2019
Last updated
01/18/2024
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