Healthcare Provider Details

I. General information

NPI: 1609158468
Provider Name (Legal Business Name): JENTRI LIND HAMES LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 MONO AVE
MINDEN NV
89423-4212
US

IV. Provider business mailing address

1638 MONO AVE
MINDEN NV
89423-4212
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-5134
  • Fax:
Mailing address:
  • Phone: 775-782-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number8526-S
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: