Organization
THREE RIVERS MENTAL HEALTH AND CHEMICAL DEPENDENCY CENTER
Active
Other names
Three Rivers Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE BERG (BILLING MANAGER)
(605) 374-3862
Entity
Organization
Contact information
Practice address
11 EAST 4TH STREET, LEMMON, SD 57638-0447
(605) 374-3862
(605) 374-3864
Mailing address
11 EAST 4TH ST., P.O. BOX 447, LEMMON, SD 57638-0447
(605) 374-3862
(605) 374-3864
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1082
SD
101YM0800X
Mental Health Counselor
1162
SD
101YM0800X
Mental Health Counselor
1948
SD
101YM0800X
Mental Health Counselor
Primary
LPC1098
SD
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003226
BCBS GROUP PROVIDER #
SD
01
—
1234567
JASON LILLICH
SD
01
—
4994184
MIKKI KENNEDY-HAINES ID#
SD
Enumeration date
08/18/2006
Last updated
01/08/2024
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