Jan Psillos – Counselor in Chesterfield, SC

Key facts

NPI: 1760957286
Entity type: Individual (NPI type 1)
Primary specialty: Counselor 101Y00000X
Practice address: 207 Commerce Ave
Chesterfield, SC 29709
Phone: (843) 623-2229
NPI assigned: Oct 11, 2018
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

South Carolina Dept of Mental Health Accounting Office Community/Behavioral Health Agency · Columbia, SC · NPI 1083421994

NPD (past)
South Carolina Dept of Mental Health Accounting Office Mental Health Clinic/Center (Including Community Mental Health Center) · Bennetsville, SC · NPI 1609979640

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
South Carolina Dept of Mental Health Accounting Office		Past	Accepting new patients
South Carolina Dept of Mental Health Accounting Office		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor	101Y00000X			Yes

Addresses

Primary practice location

207 Commerce Ave
Chesterfield, SC 29709

Mailing address

PO Box 918
Bennettsville, SC 29512
Phone (843) 544-4060

Other identifiers

Identifier	Type	State	Issuer
405127	Medicaid	SC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 11, 2018.

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539216000000",
    "number": "1760957286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 918",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "29512",
            "telephone_number": "843-544-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 COMMERCE AVE",
            "city": "CHESTERFIELD",
            "state": "SC",
            "postal_code": "29709",
            "telephone_number": "843-623-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PSILLOS",
        "first_name": "JAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-11",
        "last_updated": "2018-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405127",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, SC

All providers in Chesterfield, SC · Counselor in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2018. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.