Provider Demographics
NPI:1528699493
Name:PALECEK THERAPY AND CONSULTING LLC
Entity type:Organization
Organization Name:PALECEK THERAPY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALECEK
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, QMHP
Authorized Official - Phone:605-222-4398
Mailing Address - Street 1:2218 JACKSON BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3452
Mailing Address - Country:US
Mailing Address - Phone:605-467-5847
Mailing Address - Fax:605-791-0122
Practice Address - Street 1:2218 JACKSON BLVD STE 13
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3452
Practice Address - Country:US
Practice Address - Phone:605-222-4398
Practice Address - Fax:605-791-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC-MH30602OtherSD BOARD OF EXAMINERS
SD1528699493OtherNPI II