Healthcare Provider Details

I. General information

NPI: 1811290992
Provider Name (Legal Business Name): BLACK HILLS PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2710
US

IV. Provider business mailing address

115 N 7TH ST STE 6
SPEARFISH SD
57783-2710
US

V. Phone/Fax

Practice location:
  • Phone: 605-645-0100
  • Fax: 605-717-1009
Mailing address:
  • Phone: 605-645-0100
  • Fax: 605-717-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0000
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000000
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateSD
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0000
License Number StateSD
# 9
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0000
License Number StateSD

VIII. Authorized Official

Name: DR. SHANNON JEAN MAXWELL
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: PSY.D
Phone: 513-304-4750