Wakiyan Peta, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

7051316 Issued in SD

Practice address

24276 166TH St
Eagle Butte, SD 57625-8141

Phone

(605) 964-0722

Fax

(605) 964-8905

NPI assigned

Sep 29, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1043090822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 83",
            "city": "LANTRY",
            "state": "SD",
            "postal_code": "576360083",
            "telephone_number": "605-200-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24276 166TH ST",
            "city": "EAGLE BUTTE",
            "state": "SD",
            "postal_code": "576258141",
            "telephone_number": "605-964-0722",
            "fax_number": "605-964-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETA",
        "first_name": "WAKIYAN",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "SD",
            "license": "7051316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Catherine Morse, RN
• Shantel Norman, DPT
• Samantha Renee Orrill
• Alycia Oster, RN
• Randi Peacock
• Amalia Marie Petersen, RN
• Lethi Bui Pham, RPH
• Ylien Phung
• Ellen Pietsch
• Prairie Community Health, Inc. (Eagle Butte Schools)

• Addiction (Substance Use Disorder) Counselor in Eagle Butte, SD
• Providers in Eagle Butte, SD by specialty
• Addiction (Substance Use Disorder) Counselor in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.