Individual
MARK WILLIAM PERRENOUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1818 W FULTON ST, SUITE 201, RAPID CITY, SD 57702-4347
(605) 348-6500
(605) 341-7409
Mailing address
1818 W FULTON ST, SUITE 201, RAPID CITY, SD 57702-4347
(605) 348-6500
(605) 341-7409
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
316
SD
103TC1900X
Counseling Psychologist
316
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6550895
—
SD
Enumeration date
02/20/2006
Last updated
03/29/2012
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