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NPI Code Detail

MEDICARE: BLACK HILLS PSYCHOLOGY, LLC

MEDICARE: BLACK HILLS PSYCHOLOGY, LLC
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
12084P0804XChild & Adolescent Psychiatry Physician
21041C0700XClinical Social Worker0000SD
3101YM0800XMental Health CounselorSD
4103TC1900XCounseling PsychologistSD
5101YP2500XProfessional Counselor000000SD
6363LP0808XPsychiatric/Mental Health Nurse PractitionerSD
72084P0800XPsychiatry Physician
8103TC2200XClinical Child & Adolescent Psychologist0000SD
9103TC0700XClinical Psychologist0000SD

Other Identifiers

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

General Provider Information

NPI Number : 1811290992
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK HILLS PSYCHOLOGY, LLC
Provider Business Mailing Address
First Line : 115 N 7TH ST STE 6
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2710
Country : US
Telephone Number : 605-645-0100
Fax Number : 605-717-1009
Provider Business Practice Location Address
First Line : 115 N 7TH ST STE 6
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2710
Country : US
Telephone Number : 605-645-0100
Fax Number : 605-717-1009
Authorized Official
Title or Position : OWNER, AUTHORIZED OFFICIAL
Name : DR. SHANNON JEAN MAXWELL
Credential : PSY.D
Telephone Number : 513-304-4750
Provider Enumeration Date : 12/13/2010
Last Update Date : 01/20/2026

Similar Medicare Providers

1790058089 — SHANNON JEAN MAXWELL PSY.D, LP
Practice Location Address:
115 N 7TH ST STE 6
SPEARFISH, SD
57783-2710
Practice Phone: 605-645-0100
Practice Fax: 605-717-1009
1457325276 — VERNA JEAN SCHAD CNP
Practice Location Address:
115 N 7TH ST STE 6
SPEARFISH, SD
57783-2710
Practice Phone: 605-645-0100
Practice Fax: 605-717-1009
1952433302 — RITA LARAE VAN NORMAN LCSW
Practice Location Address:
115 N 7TH ST STE 6
SPEARFISH, SD
57783-2710
Practice Phone: 605-645-0100
Practice Fax: 605-717-1009
1184910911 — DR. CHERISE DEANN LEREW PHD
Practice Location Address:
115 N. 7TH ST. , STE 6
SPEARFISH, SD
57783-2710
Practice Phone: 605-645-0100
Practice Fax: 605-717-1009
1114357134 — MRS. RACHEL PETTERSEN LPC-MH, QMHP
Practice Location Address:
115 N 7TH ST STE 4
SPEARFISH, SD
57783-2710
Practice Phone: 605-641-2661
Practice Fax: 605-644-5121
1750788303 — NANCY SPRYNCZYNATYK LPC-MH
Practice Location Address:
115 N 7TH ST STE 6
SPEARFISH, SD
57783-2710
Practice Phone: 605-645-0100
Practice Fax: 605-717-1009

Directions to “BLACK HILLS PSYCHOLOGY, LLC ” Practice Location

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