Southern Psychological and Behavioral Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY003935 Issued in GA

Legal business name

SOUTHERN PSYCHOLOGICAL AND BEHAVIORAL SERVICES, LLC

Practice address

202 W Gordon St
Suite D
Valdosta, GA 31601-4569

Phone

(229) 474-9800

Fax

(229) 515-4443

NPI assigned

May 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Twyla Lucinda Mancil, PH. D.NPI 1447677828

Title

Licensed Psychologist/Owner

Phone

(352) 727-8679

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SPBS Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Twyla Lucinda Mancil, PH. D.

  • Psychologist
  • Valdosta, GA
  • NPI 1447677828
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1164870408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 W GORDON ST",
            "address_2": "SUITE D",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316014569",
            "telephone_number": "229-474-9800",
            "fax_number": "229-515-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 W GORDON ST",
            "address_2": "SUITE D",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316014569",
            "telephone_number": "229-474-9800",
            "fax_number": "229-515-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PSYCHOLOGICAL AND BEHAVIORAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "MANCIL",
        "authorized_official_first_name": "TWYLA",
        "authorized_official_middle_name": "LUCINDA",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "352-727-8679",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH. D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY003935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00316809A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPBS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychologist in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.