Healthcare Provider Details

I. General information

NPI: 1770988495
Provider Name (Legal Business Name): FAMILY COUNSELING SERVICE OF NORTHERN NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E PLUMB LN
RENO NV
89502-3540
US

IV. Provider business mailing address

575 E PLUMB LN
RENO NV
89502-3540
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-0623
  • Fax: 775-322-2059
Mailing address:
  • Phone: 775-329-0623
  • Fax: 775-322-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC200611022336
License Number StateNV

VIII. Authorized Official

Name: STUART CHARLES GORDON JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 775-329-0623