Healthcare Provider Details

I. General information

NPI: 1245418425
Provider Name (Legal Business Name): STEPHANIE KAY MCMULLEN CSW INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE KAY KORF LSW, MSW

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN SUITE #100
RENO NV
89509-4932
US

IV. Provider business mailing address

7475 LA COSTA ST
SPARKS NV
89436-6425
US

V. Phone/Fax

Practice location:
  • Phone: 775-334-3033
  • Fax: 775-334-3022
Mailing address:
  • Phone: 775-770-8505
  • Fax: 775-334-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4655-S
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC987
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: