Mindful Behavioral Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

20152393 Issued in SC

Legal business name

MINDFUL BEHAVIORAL INC

Practice address

323 Mercy St
Lake City, SC 29560-2331

Phone

(843) 374-4494

Fax

(888) 974-8541

NPI assigned

Jul 30, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Akila Proctor

Title

Ceo

Phone

(919) 697-0767

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1326423443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 MIDDLEBURG DR",
            "address_2": "SUITE 105",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042415",
            "telephone_number": "803-569-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 MERCY ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602331",
            "telephone_number": "843-374-4494",
            "fax_number": "888-974-8541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIORAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "AKILA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-697-0767",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": "20152393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle Moses

• Community/Behavioral Health Agency in Lake City, SC
• Providers in Lake City, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.