Healthcare Provider Details

I. General information

NPI: 1972019131
Provider Name (Legal Business Name): TLC SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 CARLIN ST APT 6
RENO NV
89503-4212
US

IV. Provider business mailing address

1425 CARLIN ST APT 6
RENO NV
89503-4212
US

V. Phone/Fax

Practice location:
  • Phone: 775-219-0524
  • Fax:
Mailing address:
  • Phone: 775-219-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JUSTIN T EMERSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 775-219-0524