Organization
TOKATA ETUNWAN WAKANYEZA OWICAKIYAPI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARISSE NICHELLE BORDEAUX MS, LPC, NCC, QMHP (DIRECTOR OF COUNSELOR EDUCATION)
(605) 515-3511
Entity
Organization
Contact information
Practice address
28572 BIA 1, ROSEBUD, SD 57570
(605) 515-3511
Mailing address
PO BOX 253, ROSEBUD, SD 57570-0253
(605) 515-3511
(605) 515-3511
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/05/2025
Last updated
12/05/2025
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