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1710 E Grand Xing Mobridge SD 57601-1414 | |
| (605) 845-2058 | |
| (606) 845-2062 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1710 E Grand Xing, Mobridge, South Dakota |
| Authorized Official Name and Position | Jessica Lynne Haefner (OWNER) |
| Authorized Official Contact | 6058452058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1710 E Grand Xing Mobridge SD 57601-1414 Ph: (605) 845-2058 | 1710 E Grand Xing Mobridge SD 57601-1414 Ph: (605) 845-2058 |
| NPI Number | 1457720476 |
|---|---|
| Provider Enumeration Date | 09/21/2015 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/03/2024 |
| Medicare PECOS PAC ID | 2961948286 |
|---|---|
| Medicare Enrollment ID | O20240723003214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457720476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 695-8-1-11-245 (North Dakota) | Secondary |
| 251S00000X | Community/behavioral Health | LPCMH2303 (South Dakota) | Primary |
| Provider Name | Jessica Lynne Haefner |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1114339413 PECOS PAC ID: 3779029095 Enrollment ID: I20240723003451 |
| Provider Name | Rebecca Lynn Christiansen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699387373 PECOS PAC ID: 2163968199 Enrollment ID: I20240725002573 |
Great Plains Area Youth Regional Treatment Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 12451 Hwy 1806, Mobridge, SD 57601 Phone: 605-226-7341 | |
Mobridge Regional Hospital Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1401 10th Ave W, Mobridge, SD 57601 Phone: 605-845-3692 Fax: 605-845-8252 |