Healthcare Provider Details

I. General information

NPI: 1831342617
Provider Name (Legal Business Name): HEAL THERAPY OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N ROOP ST
CARSON CITY NV
89701
US

IV. Provider business mailing address

405 N ROOP ST
CARSON CITY NV
89701-4778
US

V. Phone/Fax

Practice location:
  • Phone: 775-884-9911
  • Fax:
Mailing address:
  • Phone: 775-884-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 24336
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-509
License Number StateNV

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1124219712
Identifier TypeOTHER
Identifier StateNV
Identifier IssuerMEDICAID PROVIDER GROUP NPI

VIII. Authorized Official

Name: SUZANNE PINDELL
Title or Position: OWNER
Credential:
Phone: 775-884-9911