Healthcare Provider Details

I. General information

NPI: 1063901155
Provider Name (Legal Business Name): BOARD OF REGENTS, NEVADA SYSTEM OF HIGHER EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 WEST MOANA LANE
RENO NV
89509
US

IV. Provider business mailing address

1664 NORTH VIRGINIA STREET PSYCHOLOGY DEPARTMENT/MAIL STOP 296
RENO NV
89557
US

V. Phone/Fax

Practice location:
  • Phone: 775-682-8686
  • Fax: 775-784-1126
Mailing address:
  • Phone: 775-682-8686
  • Fax: 775-784-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0001
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CLAUDIA CERVANTES
Title or Position: ADMINISTRATIVE ASSISTANT II
Credential:
Phone: 775-682-8686