Healthcare Provider Details

I. General information

NPI: 1235070137
Provider Name (Legal Business Name): INNOVATIVE MANAGED BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 MOUNT MAHOGANY COURT
RENO NV
89511
US

IV. Provider business mailing address

18124 WEDGE PKWY STE 245
RENO NV
89511-8134
US

V. Phone/Fax

Practice location:
  • Phone: 775-772-7017
  • Fax:
Mailing address:
  • Phone: 775-772-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GARYN RAMOS
Title or Position: CEO
Credential:
Phone: 775-772-7107