Healthcare Provider Details

I. General information

NPI: 1154621514
Provider Name (Legal Business Name): BRIARWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY 8C
SPARKS NV
89431-5564
US

IV. Provider business mailing address

480 GALLETTI WAY 8C
SPARKS NV
89431-5564
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-1490
  • Fax: 775-324-1541
Mailing address:
  • Phone: 775-324-1490
  • Fax: 775-324-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberX
License Number StateNV

VIII. Authorized Official

Name: MS. ASHLEIGH S HEUER
Title or Position: HR
Credential:
Phone: 775-324-1490