Healthcare Provider Details

I. General information

NPI: 1215580881
Provider Name (Legal Business Name): TURNING TIDES THERAPY & MEDIATION DBA: CENTER FOR THERAPY & MEDIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 12/22/2019
Certification Date: 12/22/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W HUFFAKER LN STE 302
RENO NV
89511-2091
US

IV. Provider business mailing address

180 W HUFFAKER LN STE 302
RENO NV
89511-2091
US

V. Phone/Fax

Practice location:
  • Phone: 775-842-5669
  • Fax: 775-501-8783
Mailing address:
  • Phone: 775-842-5669
  • Fax: 775-501-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOY QUANRUD GRIMSLEY
Title or Position: OWNER
Credential: MFT
Phone: 775-842-5669