Healthcare Provider Details

I. General information

NPI: 1871897470
Provider Name (Legal Business Name): SIERRA HOLISTIC COUNSELOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 ROCK BLVD
SPARKS NV
89431-4361
US

IV. Provider business mailing address

1436 CANYON CREEK RD
RENO NV
89523-1703
US

V. Phone/Fax

Practice location:
  • Phone: 775-772-2064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1260
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI-0168
License Number StateNV

VIII. Authorized Official

Name: GINA MAUREEN FLORES-O'TOOLE
Title or Position: OWNER
Credential: ED.S., LADC, LMFT-I
Phone: 775-772-2064