Healthcare Provider Details

I. General information

NPI: 1255635421
Provider Name (Legal Business Name): GRGICH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BASIN AVE SUITE 302
PAHRUMP NV
89060-4611
US

IV. Provider business mailing address

1601 E BASIN SUITE 302
PAHRUMP NV
89048-4612
US

V. Phone/Fax

Practice location:
  • Phone: 775-751-1349
  • Fax:
Mailing address:
  • Phone: 775-751-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPYO413
License Number StateNV

VIII. Authorized Official

Name: BECKIE GRGICH
Title or Position: PRESIDENT
Credential: PSYD
Phone: 775-751-1349