BLACK HILLS PSYCHOLOGY, LLC — NPI 1811290992 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1811290992

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TC0700X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical

Box 32 Service Location & ZIP+4

115 N 7TH ST STE 6, SPEARFISH, SD, 57783-2710

✓ 9-Digit EDI 837 ZIP+4 (57783-2710)

Practice Phone & Referral Fax

(605) 645-0100

Fax: (605) 717-1009

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1811290992 (BLACK HILLS PSYCHOLOGY, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1811290992` (NPI-2 Organization / Facility)
Provider / Legal Name	BLACK HILLS PSYCHOLOGY, LLC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical NUCC Code: `103TC0700X` (Psychologist, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	115 N 7TH ST STE 6, SPEARFISH, SD, 57783-2710
Practice Telephone / Fax	Tel: (605) 645-0100 \| Fax: (605) 717-1009
Administrative Mailing Address	115 N 7TH ST STE 6, SPEARFISH, SD, 57783-2710
Enumeration & Last Sync	Enumerated: 2010-12-13 \| CMS Record Updated: 2026-01-20
Authorized Official	SHANNON MAXWELL (Owner, Authorized Official)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

115 N 7TH ST STE 6, SPEARFISH, SD, 57783-2710

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Plain-English Taxonomy & CMS Crosswalk (103TC0700X)

What Does Taxonomy Code 103TC0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical) • CMS Code 68 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BLACK HILLS PSYCHOLOGY, LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2084P0804X` — Psychiatry & Neurology, Child & Adolescent Psychiatry Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: N/A \| License: `Verified` \| Primary: Secondary
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: SD \| License: `0000` \| Primary: Secondary
`101YM0800X` — Counselor, Mental Health Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: SD \| License: `Verified` \| Primary: Secondary
`103TC1900X` — Psychologist, Counseling Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling	State: SD \| License: `Verified` \| Primary: Secondary
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: SD \| License: `000000` \| Primary: Secondary
`363LP0808X` — Nurse Practitioner, Psych/Mental Health Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Psychiatric — Mental Health	State: SD \| License: `Verified` \| Primary: Secondary
`2084P0800X` — Psychiatry & Neurology, Psychiatry Plain English: Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`103TC2200X` — Psychologist, Clinical Child & Adolescent Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical Child & Adolescent	State: SD \| License: `0000` \| Primary: Secondary
`103TC0700X` — Psychologist, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical	State: SD \| License: `0000` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BLACK HILLS PSYCHOLOGY, LLC (NPI #1811290992)