Organization
COMMUNITY COUNSELING SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY ROTERT (ACCOUNTS RECEIVABLE)
(605) 352-8596
Entity
Organization
Contact information
Practice address
357 KANSAS AVE SE, HURON, SD 57350-2517
(605) 352-8596
(605) 352-7001
Mailing address
357 KANSAS AVE SE, HURON, SD 57350-2517
(605) 352-8596
(605) 352-7001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2
SD
101YM0800X
Mental Health Counselor
Primary
1
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S69975
GROUP MEDICARE NUMBER
SD
Enumeration date
05/03/2006
Last updated
08/09/2022
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