MEDICARE: INNER PEACE BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487882924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER PEACE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	801 12TH AVE S
Second Line	:	SUITE B
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3765
Country	:	US
Telephone Number	:	843-663-0828
Fax Number	:	843-492-6766

Provider Business Practice Location Address
First Line	:	801 12TH AVE S
Second Line	:	STE B
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3765
Country	:	US
Telephone Number	:	843-663-0828
Fax Number	:	843-663-0828

Authorized Official
Title or Position	:	THERAPIST & OWNER
Name	:	BEVIN NIXON
Credential	:	LCSW
Telephone Number	:	609-803-3077

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	03/06/2024

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Directions to “INNER PEACE BEHAVIORAL HEALTH ” Practice Location

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