Individual
NICOLA PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 W 69TH ST, SIOUX FALLS, SD 57108-8170
(605) 322-4304
Mailing address
4400 W 69TH ST, SIOUX FALLS, SD 57108-8170
(605) 322-4304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
SD
101YM0800X
Mental Health Counselor
Primary
LPC-MH30581
—
101YM0800X
Mental Health Counselor
LPC20540
SD
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
08/20/2019
Last updated
04/20/2023
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