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General NPI Number Information
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NPI Number | 1770146540
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Entity Type | Organization
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Legal Business Name | MIDLAND VALLEY BEHAVIORAL HEALTH & CONSULTING, LLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 3524 JEFFERSON DAVIS HWY
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City | GRANITEVILLE
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State | SC
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Zip | 29829
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Country | US
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Telephone | 803-380-9004
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Fax | 803-369-3240
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Provider Business Mailing Address
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Address Line | 388 BRIDLE PATH RD
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City | NORTH AUGUSTA
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State | SC
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Zip | 29860-9085
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Country | US
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Telephone | 803-640-5101
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Fax | 803-369-3240
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | JAY EARLES
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Credential | PSYD
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Telephone | 803-380-9004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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