Provider Demographics
NPI:1619779188
Name:POOR BEAR, PTE SKA HINAPA WI
Entity type:Individual
Prefix:MS
First Name:PTE SKA HINAPA WI
Middle Name:
Last Name:POOR BEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BUFFALO HEART WOMAN
Other - Middle Name:
Other - Last Name:POOR BEAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:729 LIMIT AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3560
Mailing Address - Country:US
Mailing Address - Phone:605-585-8787
Mailing Address - Fax:605-585-8787
Practice Address - Street 1:2611 ELDERBERRY BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-5970
Practice Address - Country:US
Practice Address - Phone:605-355-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty