Healthcare Provider Details

I. General information

NPI: 1831450915
Provider Name (Legal Business Name): RACHEL ARVELLA PRYDE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ARVELLA JAYNES PCSW

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 HIGHWAY 395 N SUITE D
MINDEN NV
89423
US

IV. Provider business mailing address

1644 HIGHWAY 395 N SUITE D
MINDEN NV
89423
US

V. Phone/Fax

Practice location:
  • Phone: 307-880-7224
  • Fax:
Mailing address:
  • Phone: 307-880-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79420
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-930
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-496
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number496
License Number StateWY
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8049-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: