Healthcare Provider Details

I. General information

NPI: 1922432012
Provider Name (Legal Business Name): YESENIA ARIEL CARRIZALES LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YESENIA ARIEL CARRIZALES LSW

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SAFE HARBOR WAY
RENO NV
89512-1137
US

IV. Provider business mailing address

3700 SAFE HARBOR WAY
RENO NV
89512
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-9411
  • Fax:
Mailing address:
  • Phone: 775-787-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: