Provider Demographics
NPI:1528499621
Name:BLACK HILLS NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:BLACK HILLS NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-410-3514
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-0992
Mailing Address - Country:US
Mailing Address - Phone:201-410-3514
Mailing Address - Fax:
Practice Address - Street 1:3650 RANGE RD
Practice Address - Street 2:ROOM #101
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0627
Practice Address - Country:US
Practice Address - Phone:201-410-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-28
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD518103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty