Life Light Counseling, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LIFE LIGHT COUNSELING, INC.

Practice address

1315 N Main St
Suite 100
Mitchell, SD 57301-1359

Phone

(605) 996-2070

Fax

(605) 996-2395

NPI assigned

Nov 16, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kim M Reid, CCDCII

Title

Executive Director

Phone

(605) 996-2070

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew D Christiansen, PHD

  • Clinical Psychologist
  • Mitchell, SD
  • NPI 1639136088
  NPD (past)
• Dustin Brooks Tanner, PSYD

  • Clinical Psychologist
  • Mitchell, SD
  • NPI 1497995088
  NPD (past)

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649343922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 N MAIN ST",
            "address_2": "SUITE 100",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011359",
            "telephone_number": "605-996-2070",
            "fax_number": "605-996-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 N MAIN ST",
            "address_2": "SUITE 100",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573011359",
            "telephone_number": "605-996-2070",
            "fax_number": "605-996-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE LIGHT COUNSELING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REID",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "605-996-2070",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CCDCII"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5000270",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chris C Krouse, DO
• Karin R Larson, MA-CCC/SLP
• Jeffrey Lee, MPT
• Dennis Gordon Leland, MD
• Kimberly L Lienemann, LIMHP NE; LPC-MH SD
• Lifequest
• Lifequest
• Lifequest
• Lifequest
• Lifequest

• Community/Behavioral Health Agency in Mitchell, SD
• Providers in Mitchell, SD by specialty
• Community/Behavioral Health Agency in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.