Healthcare Provider Details

I. General information

NPI: 1093169229
Provider Name (Legal Business Name): ENGELBERT MITTERMAYR LPC, CRC, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CARSON ST STE 45
CARSON CITY NV
89701-1216
US

IV. Provider business mailing address

1805 N CARSON ST STE 45
CARSON CITY NV
89701-1216
US

V. Phone/Fax

Practice location:
  • Phone: 775-741-4716
  • Fax:
Mailing address:
  • Phone: 775-775-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8140
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI0373
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: