| Mark W. Perrenoud Ph.d. Inc. | |
|
1818 West Fulton Suite 201 Rapid City SD 57702-4347 | |
| (605) 348-6500 | |
| (605) 341-7409 |
| Full Name | Mark W. Perrenoud Ph.d. Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1818 West Fulton, Rapid City, South Dakota |
| Authorized Official Name and Position | Mark William Perrenoud (PRESIDENT) |
| Authorized Official Contact | 6053486500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark W. Perrenoud Ph.d. Inc. 1818 West Fulton Suite 201 Rapid City SD 57702-4347 Ph: (605) 348-6500 | Mark W. Perrenoud Ph.d. Inc. 1818 West Fulton Suite 201 Rapid City SD 57702-4347 Ph: (605) 348-6500 |
| NPI Number | 1013283670 |
|---|---|
| Provider Enumeration Date | 03/28/2012 |
| Last Update Date | 03/28/2012 |
| Medicare PECOS PAC ID | 6901068311 |
|---|---|
| Medicare Enrollment ID | O20120501000687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013283670 | NPI | - | NPPES |
| 6550895 | Medicaid | SD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 316 (South Dakota) | Primary |
| Provider Name | Mark W Perrenoud |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588639033 PECOS PAC ID: 2961664370 Enrollment ID: I20120501000721 |
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