MIDLANDS NEUROBEHAVIORAL SERVICES, LLC (NPI# 1447709431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447709431 |
| Entity Type | Organization |
| Organization Name | MIDLANDS NEUROBEHAVIORAL SERVICES, LLC |
| Practice Address |
160 Medical Cir Ste E West Columbia SC 29169-3639 |
| Practice Telephone | 8037089638 |
| Practice Fax Number | 8883527678 |
| Mailing Telephone | 8037089638 |
| Mailing Fax Number | 8883527678 |
| Enumeration Date | 2016-10-02 |
| Last Update Date | 2019-05-03 |
| Authorized Official Name | DR. SHAWNA BLAKE KIRBY (CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 8037089638 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | 1251 | SC | Behavioral Health & Social Service Providers |
| Y | 103G00000X | Clinical Neuropsychologist | 1251 | SC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | PS0613 | 05 |
| Street Address |
160 MEDICAL CIR STE E |
| City | WEST COLUMBIA |
| State | SC |
| Zip Code | 29169-3639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346758240 | Elizabeth Ruth Eells | Social Worker | 160 Medical Cir Ste E, West Columbia, SC 29169-3639 | 2018-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457960726 | Jerry Scott Oreilly | Physical Therapy Assistant | 100 Dreher Rd, Suite 100, West Columbia, SC 29169 | 2020-07-23 |
| 1134759921 | A&m Medical, LLC | Durable Medical Equipment & Medical Supplies | 1053 Sunset Boulevard, West Columbia, SC 29169 | 2020-01-21 |
| 1750946067 | First Physical Therapy, LLC | Clinic/Center | 100 Dreher Rd., Suite 100, West Columbia, SC 29169 | 2019-05-02 |
| 1295217545 | Tynaka Kwans Wilson | Nurse Practitioner | Sc House Calls Inc, 1053 Center Street, West Columbia, SC 29169 | 2018-09-04 |
| 1588183826 | Kimberly Jane Jennings | Registered Nurse | 1052 Center Street, Sc House Calls Inc, West Columbia, SC 29169 | 2017-09-19 |
| 1164943213 | Jacob Luke Wayland | Emergency Medicine | Lexington Medical Center-emergency Medicine Dept, 2720 Sunset Blvd, West Columbia, SC 29169 | 2017-06-29 |
| 1740721232 | Heather Detwiler | Physical Therapy Assistant | 2705 Leaphart Rd., Carolina Gardens, West Columbia, SC 29169 | 2017-03-16 |
| 1588110761 | Virginia I Hall | Nurse Practitioner | 2720 Susnet Blvd, West Columbia, SC 29169 | 2016-08-29 |
| 1215395744 | Stacey Khalifa | Social Worker | 160 Medical Cir Fl 1, West Columbia, SC 29169 | 2016-01-28 |
| 1407252331 | Sandy Frye Boone | Counselor | 2318 Sunset Blvd # 2a, West Columbia, SC 29169 | 2014-11-04 |
| Find all providers in zip 29169 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801352695 | Capital City Neuropsychology, LLC | Clinical Neuropsychologist | 6000 Garners Ferry Rd Ste 12, Columbia, SC 29209-1303 | 2019-02-16 |
| 1417446204 | Michael Adam Sugarman | Clinical Neuropsychologist | 1459 Stuart Engals Blvd Ste 204a, Mt Pleasant, SC 29464 | 2018-05-07 |
| 1184132193 | South Carolina Neuro, LLC | Clinical Neuropsychologist | 29 Leinbach Drive, D4, Charleston, SC 29407-7086 | 2018-01-12 |
| 1083000798 | Andrea Sartori | Clinical Neuropsychologist | 107 W 5th North St Ste 102, Summerville, SC 29483 | 2015-04-09 |
| 1366724361 | Jesse Daniel Chasman | Clinical Neuropsychologist | 1608 Paradise Lake Dr, Mount Pleasant, SC 29464-5719 | 2011-09-15 |
| 1104091404 | Anne C Saravo | Clinical Neuropsychologist | 1460 Gleasons Landing Dr, St Helena Island, SC 29920-3814 | 2008-04-28 |
| 1427261783 | Charleston Psychiatry | Clinical Neuropsychologist | 9929 F University Blvd, 2 B, Charleston, SC 29406 | 2007-05-07 |
| 1336364892 | Leonard Goldschmidt | Clinical Neuropsychologist | 4882 Socastee Blvd, Myrtle Beach, SC 29588-7245 | 2007-04-17 |
| 1255460747 | Pedinet, LLC | Clinical Neuropsychologist | 34 Heritage Point Dr, Simpsonville, SC 29681-3245 | 2007-03-02 |
| 1174686356 | Shawna Blake Kirby | Clinical Neuropsychologist | 1705 Richland St, Columbia, SC 29201-2635 | 2006-12-18 |
| Find all providers with the same taxonomy | ||||
| City | WEST COLUMBIA |
| Zip Code | 29169 |
Please comment or provide details below to improve the information on MIDLANDS NEUROBEHAVIORAL SERVICES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.