Organization
MINDLAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY SHAW APRN (PMHNP/PARTNER)
(843) 321-5099
Entity
Organization
Contact information
Practice address
2423 HIGHWAY 17 S, NORTH MYRTLE BEACH, SC 29582-4343
(843) 321-5099
Mailing address
2423 HIGHWAY 17 S, NORTH MYRTLE BEACH, SC 29582-4343
(843) 321-5099
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/03/2023
Last updated
10/03/2023
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