Provider Demographics
NPI:1396628939
Name:PEDIATRIC COUNSELING AND CONSULTATION LLC
Entity type:Organization
Organization Name:PEDIATRIC COUNSELING AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-661-8978
Mailing Address - Street 1:2650 JACKSON BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3474
Mailing Address - Country:US
Mailing Address - Phone:605-545-0045
Mailing Address - Fax:
Practice Address - Street 1:2650 JACKSON BLVD STE 5
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3474
Practice Address - Country:US
Practice Address - Phone:605-545-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty