MEDICARE: SIERRA HOLISTIC COUNSELOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI-0168	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1260	NV

General Provider Information

NPI Number	:	1871897470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA HOLISTIC COUNSELOR

Provider Business Mailing Address
First Line	:	1436 CANYON CREEK RD
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 ROCK BLVD
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89431-4361
Country	:	US
Telephone Number	:	775-772-2064
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GINA MAUREEN FLORES-O'TOOLE
Credential	:	ED.S., LADC, LMFT-I
Telephone Number	:	775-772-2064

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	12/22/2010

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