NPIMap

Organization Active NPI

Southside Behavioral Health

  • Community/Behavioral Health Agency
  • Clarksville, VA
National Provider Identifier
1700890761
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SOUTHSIDE BEHAVIORAL HEALTH
Practice address
143 Industrial Parkway
Clarksville, VA 23927
Phone
(434) 572-6916
Fax
(434) 374-3321
NPI assigned
Jul 27, 2006
Last updated
Mar 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Elizabeth C Engelhorn, LPCNPI 1285838102
Title
Executive Director
Phone
(434) 572-6916

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 090 VA
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 090 VA
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 090 VA
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

143 Industrial Parkway
Clarksville, VA 23927

Mailing address

PO Box 1478
143 Industrial Parkway
Clarksville, VA 23927
Phone (434) 572-6916

Other practice location 1

2087 Lawrenceville Plank Road
Lawrenceville, VA 23868
Phone (434) 848-4121

Other practice location 2

523 Madison Street
Boydton, VA 23917
Phone (434) 738-0154

Other names 1

  • Southside Community Services Board Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050708000612 VA Part B Supplier - Clinic/Group Practice 4284660507 Receives reassigned benefits from 79 practitioners
Practice locations: Boydton, VA; Clarksville, VA; Lawrenceville, VA; South Boston, VA; South Hill, VA

National Provider Directory

National Provider Directory
Tax ID family
Southside Behavioral Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

523 Madison St
Boydton, VA 23917
Phone (434) 738-0154

143 Industrial Pkwy
Clarksville, VA 23927
Phone (434) 572-6916

3030 Philpott Rd
South Boston, VA 24592
Phone (434) 572-9563

424 Hamilton Blvd
South Boston, VA 24592
Phone (434) 572-2936

Practitioners & affiliated clinicians

Practitioners 109

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.

View all 109

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1700890761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1478",
            "address_2": "143 INDUSTRIAL PARKWAY",
            "city": "CLARKSVILLE",
            "state": "VA",
            "postal_code": "23927",
            "telephone_number": "434-572-6916",
            "fax_number": "434-374-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 INDUSTRIAL PARKWAY",
            "city": "CLARKSVILLE",
            "state": "VA",
            "postal_code": "23927",
            "telephone_number": "434-572-6916",
            "fax_number": "434-374-3321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2087 Lawrenceville Plank Road",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "VA",
            "postal_code": "23868",
            "country_code": "US",
            "telephone_number": "434-848-4121",
            "fax_number": "434-848-4148",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "523 Madison Street",
            "address_purpose": "LOCATION",
            "city": "Boydton",
            "state": "VA",
            "postal_code": "23917",
            "country_code": "US",
            "telephone_number": "434-738-0154",
            "fax_number": "434-738-9545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHSIDE BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "ENGELHORN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "434-572-6916",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "090",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "090",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "090",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Community Services Board",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clarksville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.