Provider Demographics
NPI:1972761724
Name:BECKMAN MENTAL HEALTH NEWBERRY OFFICE
Entity Type:Organization
Organization Name:BECKMAN MENTAL HEALTH NEWBERRY OFFICE
Other - Org Name:BECKMAN MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HUMAN SERVICES CORDINATOR II
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:WILKERSON
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC S
Authorized Official - Phone:803-276-8000
Mailing Address - Street 1:2043 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108
Mailing Address - Country:US
Mailing Address - Phone:803-276-8000
Mailing Address - Fax:
Practice Address - Street 1:2043 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2249
Practice Address - Country:US
Practice Address - Phone:803-276-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health