Healthcare Provider Details

I. General information

NPI: 1548526023
Provider Name (Legal Business Name): CHILD AND ADOLESCENT MENTAL HEALTH PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 ROBERTA LN
SPARKS NV
89431-2809
US

IV. Provider business mailing address

1055 ROBERTA LANE
SPARKS NV
89431
US

V. Phone/Fax

Practice location:
  • Phone: 775-331-8747
  • Fax: 775-331-8754
Mailing address:
  • Phone: 775-331-8747
  • Fax: 775-331-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAMELA J MOCK
Title or Position: BILLING/INSURANCE
Credential:
Phone: 775-331-6252