Psychiatric Services, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

CP000650 Issued in SD

Legal business name

PSYCHIATRIC SERVICES, LLC

Practice address

306 4TH St
Suite G
Brookings, SD 57006-1948

Phone

(605) 697-5352

Fax

(605) 610-1561

NPI assigned

Jun 5, 2012

Last updated

Jun 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Brenda L Johnson, MS-CNPNPI 1710266473

Title

Owner

Phone

(605) 697-5352

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brenda Lenae Johnson, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Brookings, SD
  • NPI 1710266473
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1497016562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 4TH ST",
            "address_2": "SUITE G",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570061948",
            "telephone_number": "605-697-5352",
            "fax_number": "605-610-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 4TH ST",
            "address_2": "SUITE G",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570061948",
            "telephone_number": "605-697-5352",
            "fax_number": "605-610-1561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-05",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-697-5352",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS-CNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "SD",
            "license": "CP000650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20110813516668",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Brookings, SD
• Providers in Brookings, SD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.