Healthcare Provider Details

I. General information

NPI: 1710322425
Provider Name (Legal Business Name): KATRINA ZMAILA MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E JOHN ST SUITE A
CARSON CITY NV
89706-3099
US

IV. Provider business mailing address

549 IDEAL CT
RENO NV
89506-9604
US

V. Phone/Fax

Practice location:
  • Phone: 775-741-8130
  • Fax: 775-883-9803
Mailing address:
  • Phone: 775-741-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0431
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: