NPIMap

Organization Active NPI

Black Hills Psychology, LLC

  • Clinical Psychologist
  • Spearfish, SD
National Provider Identifier
1811290992
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0000 Issued in SD
Legal business name
BLACK HILLS PSYCHOLOGY, LLC
Practice address
115 N 7TH St Ste 6
Spearfish, SD 57783-2710
Phone
(605) 645-0100
Fax
(605) 717-1009
NPI assigned
Dec 13, 2010
Last updated
Jan 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Authorized official

Name
Dr. Shannon Jean Maxwell, PSY.DNPI 1790058089
Title
Owner, Authorized Official
Phone
(513) 304-4750

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SD
Mental Health Counselor 101YM0800X SD
Professional Counselor 101YP2500X 000000 SD
Clinical Psychologist 103TC0700X 0000 SD Primary
Counseling Psychologist 103TC1900X SD
Clinical Child & Adolescent Psychologist 103TC2200X 0000 SD
Clinical Social Worker 1041C0700X 0000 SD
Psychiatry Physician 2084P0800X
Child & Adolescent Psychiatry Physician 2084P0804X

Addresses

Primary practice location

115 N 7TH St Ste 6
Spearfish, SD 57783-2710

Mailing address

115 N 7TH St Ste 6
Spearfish, SD 57783-2710
Phone (605) 645-0100

Other practice location 1

2525 W Main St Ste 210
Rapid City, SD 57702-2439
Phone (605) 645-0100

Other identifiers 1

IdentifierTypeStateIssuer
2001655MedicaidSD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101228000962 SD Part B Supplier - Clinic/Group Practice 4587852009 Receives reassigned benefits from 10 practitioners
Practice locations: Rapid City, SD; Spearfish, SD

National Provider Directory

National Provider Directory

Locations

115 N 7th St
Ste 6
Spearfish, SD 57783
Phone (605) 645-0100

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768867200000",
    "number": "1811290992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 N 7TH ST STE 6",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832710",
            "telephone_number": "605-645-0100",
            "fax_number": "605-717-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N 7TH ST STE 6",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832710",
            "telephone_number": "605-645-0100",
            "fax_number": "605-717-1009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2525 W Main St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "577022439",
            "country_code": "US",
            "telephone_number": "605-645-0100",
            "fax_number": "605-717-1009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLACK HILLS PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-13",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER, AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "513-304-4750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "SD",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SD",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SD",
            "license": "000000",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SD",
            "license": "0000",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "SD",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "SD",
            "license": "0000",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "0000",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001655",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spearfish, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.