# MINDLAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295515765
- **Authorized official:** STACEY SHAW APRN (PMHNP/PARTNER)
- **Authorized official phone:** (843) 321-5099

## Contact information

- **Practice address:** 607 BRIARWOOD DR STE 6, MYRTLE BEACH, SC 29572-6733
- **Practice address phone:** (854) 237-5617
- **Practice address fax:** (854) 237-5618
- **Mailing address:** 607 BRIARWOOD DR STE 6, MYRTLE BEACH, SC 29572-6733
- **Mailing address phone:** (854) 237-5617
- **Mailing address fax:** (854) 237-5618

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/03/2023
- **Last updated:** 06/15/2026