Healthcare Provider Details

I. General information

NPI: 1396984100
Provider Name (Legal Business Name): THE LIPPERT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 BRIGHTON WAY
RENO NV
89509-3871
US

IV. Provider business mailing address

3545 BRIGHTON WAY
RENO NV
89509-3871
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-5277
  • Fax: 775-322-4212
Mailing address:
  • Phone: 775-324-5277
  • Fax: 775-322-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY0106
License Number StateNV

VIII. Authorized Official

Name: DR. JAMES G. LIPPERT
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 775-324-5277