Active NPI
David Brantley III, PSY.D.
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1336457670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3777
- Practice address
- 10130 Mallard Creek Rd
Suite 300
Charlotte, NC 28262-6000 - Phone
- (704) 944-3112
- Fax
- (704) 944-3113
- NPI assigned
- Sep 21, 2010
- Last updated
- Jul 17, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 3777 | NC | |
| Clinical Psychologist | 103TC0700X | 3777 | NC | Primary |
| Counseling Psychologist | 103TC1900X | 3777 | NC | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 3777 | NC | |
| Health Service Psychologist | 103TH0100X | 3777 | NC | |
| Group Psychotherapy Psychologist | 103TP2701X | 3777 | NC |
Addresses
Primary practice location
10130 Mallard Creek Rd
Suite 300
Charlotte, NC 28262-6000
Mailing address
10130 Mallard Creek Rd
Suite 300
Charlotte, NC 28262-6000
Phone (704) 944-3112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3777 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405555200000",
"number": "1336457670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10130 MALLARD CREEK RD",
"address_2": "SUITE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282626000",
"telephone_number": "704-944-3112",
"fax_number": "704-944-3113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10130 MALLARD CREEK RD",
"address_2": "SUITE 300",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282626000",
"telephone_number": "704-944-3112",
"fax_number": "704-944-3113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANTLEY",
"first_name": "DAVID",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-09-21",
"last_updated": "2014-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NC",
"license": "3777",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "3777",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NC",
"license": "3777",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "3777",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "NC",
"license": "3777",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "NC",
"license": "3777",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.