Healthcare Provider Details

I. General information

NPI: 1770735482
Provider Name (Legal Business Name): LYNN MARSHALL PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN STADLER PSY. D.

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

IV. Provider business mailing address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

V. Phone/Fax

Practice location:
  • Phone: 775-688-1600
  • Fax: 775-688-1616
Mailing address:
  • Phone: 775-688-1600
  • Fax: 775-688-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: