Basic Information
| Provider Information | |||||||||
| NPI: | 1972761724 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BECKMAN MENTAL HEALTH NEWBERRY OFFICE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BECKMAN MENTAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2043 MEDICAL PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032768000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2043 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291082249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032768000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 05/29/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PRUITT | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | WILKERSON | ||||||||
| AuthorizedOfficialTitleorPosition: | HUMAN SERVICES CORDINATOR II | ||||||||
| AuthorizedOfficialTelephone: | 8032768000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPC S | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.