Healthcare Provider Details

I. General information

NPI: 1689215311
Provider Name (Legal Business Name): LYDIA R UREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MILL ST
RENO NV
89502-1321
US

IV. Provider business mailing address

12290 ROCKY MOUNTAIN ST
RENO NV
89506-1554
US

V. Phone/Fax

Practice location:
  • Phone: 775-636-7767
  • Fax:
Mailing address:
  • Phone: 775-313-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI5228
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: