Basic Information
| Provider Information | |||||||||
| NPI: | 1427588532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNUPPE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 JACKSON BLVD # 11 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577023474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053907055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 JACKSON BLVD # 11 | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577023474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053907055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | KNUPPE | ||||||||
| AuthorizedOfficialFirstName: | TRISCELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6053907055 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.