Healthcare Provider Details

I. General information

NPI: 1730202086
Provider Name (Legal Business Name): E&A BEHAVIORAL AND MENTAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DAYTON VALLEY RD SUITE H
DAYTON NV
89403-8928
US

IV. Provider business mailing address

PO BOX 115
DAYTON NV
89403-0115
US

V. Phone/Fax

Practice location:
  • Phone: 775-841-3116
  • Fax:
Mailing address:
  • Phone: 775-841-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number213013
License Number StateNV

VIII. Authorized Official

Name: DR. KENNETH ANTHONY EDWARDS
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 775-841-3116