NPIMap

Organization Active NPI

Piedmont Behavioral Resources, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Shelby, NC
National Provider Identifier
1366699449
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
PIEDMONT BEHAVIORAL RESOURCES, INC.
Practice address
201 W. Marion St. Ste. 207
Shelby, NC 28150
Phone
(704) 487-6226
Fax
(704) 487-6286
NPI assigned
Aug 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Authorized official

Name
Tanzy Barrow Wallace
Title
Ceo
Phone
(704) 487-6226

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 229 NC
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X MHL-023-148 NC
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 1135 NC
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 366 NC
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 5595 NC
Developmentally Disabled Services Day Training Agency 251C00000X NC Primary
Community/Behavioral Health Agency 251S00000X
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-023-046 NC

Addresses

Primary practice location

201 W. Marion St. Ste. 207
Shelby, NC 28150

Mailing address

201 W. Marion St. Ste. 207
Shelby, NC 28150
Phone (704) 487-6226

Other identifiers 7

IdentifierTypeStateIssuer
3418626MedicaidNC
6604374MedicaidNC
6604390MedicaidNC
6006639MedicaidNC
6603420MedicaidNC
8302555QMedicaidNC
8302555MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1366699449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W. MARION ST. STE. 207",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "28150",
            "telephone_number": "704-487-6226",
            "fax_number": "704-487-6286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W. MARION ST. STE. 207",
            "city": "SHELBY",
            "state": "NC",
            "postal_code": "28150",
            "telephone_number": "704-487-6226",
            "fax_number": "704-487-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIEDMONT BEHAVIORAL RESOURCES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "TANZY",
        "authorized_official_middle_name": "BARROW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-487-6226"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "229",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "MHL-023-148",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1135",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "366",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "5595",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-023-046",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418626",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604374",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604390",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006639",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603420",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302555Q",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302555",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; 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.