MEDICARE: SEAGRASS PSYCHOEDUCATIONAL SOLUTIONS 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
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1851941314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAGRASS PSYCHOEDUCATIONAL SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	25 CLARK SUMMIT DR STE 103
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4200
Country	:	US
Telephone Number	:	843-473-8213
Fax Number	:	843-582-0261

Provider Business Practice Location Address
First Line	:	25 CLARK SUMMIT DR STE 103
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4200
Country	:	US
Telephone Number	:	843-473-8213
Fax Number	:	843-582-0261

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. KRISTIN ANDERSON
Credential	:	PSY.D.
Telephone Number	:	843-473-8213

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	05/05/2026

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