Provider Demographics
NPI:1710277280
Name:CHARNLEY, IAN S (LIMHP, QMHP)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:S
Last Name:CHARNLEY
Suffix:
Gender:M
Credentials:LIMHP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W 69TH ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5622
Mailing Address - Country:US
Mailing Address - Phone:605-271-0951
Mailing Address - Fax:605-271-0951
Practice Address - Street 1:2101 W 69TH ST UNIT 103
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5622
Practice Address - Country:US
Practice Address - Phone:605-274-0095
Practice Address - Fax:605-271-0951
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE96118OtherBCBS
NE96118OtherBCBS