Midland Valley Behavioral Health & Consulting, LLC
Organization Active NPI Community/Behavioral Health Agency · Graniteville, SC
NPI 1770146540 · NPPES record last updated Apr 17, 2019
Key facts
- NPI
- 1770146540
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- MIDLAND VALLEY BEHAVIORAL HEALTH & CONSULTING, LLC
- Practice address
- 3524 Jefferson Davis Hwy
Graniteville, SC 29829 - Phone
- (803) 380-9004
- Fax
- (803) 369-3240
- NPI assigned
- Apr 17, 2019
- Organization subpart
- No
Authorized official
- Name
- Jay Earles, PSYD
- Title
- Clinical Psychologist
- Phone
- (803) 380-9004
Practitioners 1
-
Jay E Earles, PSYD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190605000141 | SC | Part B Supplier - Clinic/Group Practice | 9234462342 |
Receives reassigned benefits from 1 practitioner Practice locations: Graniteville, SC |
National Provider Directory
Locations
3524 Jefferson Davis Hwy
Graniteville, SC 29829
Phone (803) 380-9004
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
3524 Jefferson Davis Hwy
Graniteville, SC 29829
Mailing address
388 Bridle Path Rd
North Augusta, SC 29860-9085
Phone (803) 640-5101
Other providers in Graniteville, SC
- Cassi Dawn Reams Jones
- Darrell William Jones
- Love Legacy Care LLC
- Kayla McElmurray
- Jennifer Rebecca Messina
- Koshon Mitchell
- Shatori Moore
- Alexa Myers
- Tyler Reed Myers
- Angela Odom
All providers in Graniteville, SC · Community/Behavioral Health Agency 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 Apr 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.