Healthcare Provider Details

I. General information

NPI: 1992156129
Provider Name (Legal Business Name): MISS RACHEL CORNELIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PRINGLE WAY STE 300
RENO NV
89502-8425
US

IV. Provider business mailing address

1155 MILL ST MS M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-3960
  • Fax: 775-982-3727
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0004881
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0898
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: