Cody Tyler Gruber

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

101824814 Issued in SC

Practice address

1439 Thunderbolt Drive
Walterboro, SC 29488

Phone

(843) 538-4343

NPI assigned

Sep 13, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Colleton Commission on Alcohol and Drug Abuse

  • Community/Behavioral Health Agency
  • Walterboro, SC
  • NPI 1962400325

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1972272888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1439 THUNDERBOLT DRIVE",
            "city": "WALTERBORO",
            "state": "SC",
            "postal_code": "29488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1439 THUNDERBOLT DRIVE",
            "city": "WALTERBORO",
            "state": "SC",
            "postal_code": "29488",
            "telephone_number": "843-538-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBER",
        "first_name": "CODY",
        "middle_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-13",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "SC",
            "license": "101824814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tonnya G Grant
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• Allen Nathaniel Gustin, DDS
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• Amanda Stroud Hardee, PHARM.D.
• Doris Lorraine Hardee, ABOC, NCLE, LDO

• Addiction (Substance Use Disorder) Counselor in Walterboro, SC
• Providers in Walterboro, SC by specialty
• Addiction (Substance Use Disorder) Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.