Basic Information
| Provider Information | |||||||||
| NPI: | 1316281900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARNELL | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | SHANE | ||||||||
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| Credential: | MA, LPC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296468835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645543832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1547 PARKWAY | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642297120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 7265 | SC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 421504 | 05 | SC | MEDICAID |