Organization
BRIDGEWATER BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENNI L GOSCHKE PSY.D. (PRESIDENT)
(605) 791-1514
Entity
Organization
Contact information
Practice address
902 COLUMBUS ST, RAPID CITY, SD 57701-3543
(605) 791-1514
(844) 831-2349
Mailing address
PO BOX 1990, RAPID CITY, SD 57709-1990
(605) 791-1514
(844) 831-2349
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
479
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679550065
—
SD
Enumeration date
07/13/2015
Last updated
07/13/2015
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