Healthcare Provider Details

I. General information

NPI: 1780201061
Provider Name (Legal Business Name): VICTORIA JASMINE YEGHIAYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 05/22/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W MOANA LN
RENO NV
89509-4775
US

IV. Provider business mailing address

1101 W MOANA LN
RENO NV
89509-4775
US

V. Phone/Fax

Practice location:
  • Phone: 775-337-2394
  • Fax: 775-337-9570
Mailing address:
  • Phone: 775-337-2394
  • Fax: 775-337-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIC-2224
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: