Provider Demographics
NPI:1730869090
Name:BEAUFORT COUNTY STUDENT MENTAL HEALTH LLC
Entity type:Organization
Organization Name:BEAUFORT COUNTY STUDENT MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-815-6789
Mailing Address - Street 1:20 TOWNE DR STE 277
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4204
Mailing Address - Country:US
Mailing Address - Phone:843-815-6789
Mailing Address - Fax:843-815-6788
Practice Address - Street 1:1555 FORDING ISLAND RD STE C1
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1176
Practice Address - Country:US
Practice Address - Phone:843-815-6789
Practice Address - Fax:843-815-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty