Southern Psychiatric Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTHERN PSYCHIATRIC SERVICES LLC

Practice address

611 Main Street
Ste 4
Bandera, TX 78003

Phone

(830) 264-8210

NPI assigned

Apr 8, 2021

Last updated

Sep 10, 2026By 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

Jeanie Heidelberg, PMHNPNPI 1376148072

Title

Owner

Phone

(830) 264-8210

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

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.

• Jeanie K Heidelberg, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bandera, TX
  • NPI 1376148072
  Medicare reassignment Care Compare group NPD Authorized official
• Joy Perez, FNP-BC

  • Family Nurse Practitioner
  • Bandera, TX
  • NPI 1174328017

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1617840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1700465432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2624",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "780032624",
            "telephone_number": "830-264-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 MAIN STREET",
            "address_2": "STE 4",
            "city": "BANDERA",
            "state": "TX",
            "postal_code": "78003",
            "telephone_number": "830-264-8210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4333 Hwy 16 S Ste 400",
            "address_purpose": "LOCATION",
            "city": "Bandera",
            "state": "TX",
            "postal_code": "780035167",
            "country_code": "US",
            "telephone_number": "830-264-8210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN PSYCHIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-08",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "HEIDELBERG",
        "authorized_official_first_name": "JEANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-264-8210",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Seymour-Newton, LPC-A, NCC
• Teresa Shaver, RN
• Jeremy Scott Simon, MS, LCDC, LPC-I
• W Bryan Sims, DNP
• April Smith, MA, M.ED., CCC-SLP
• Sunrise Speech Therapy LLC
• Ted Sako DDS
• Texas Star Counseling and Wellness Center, PLLC
• Jeanne Diane Thacker, MSN CNS, FNP-C
• Tori D. Tucker, PHD

• Psychiatric/Mental Health Nurse Practitioner in Bandera, TX
• Providers in Bandera, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; 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.