Healthcare Provider Details

I. General information

NPI: 1437565744
Provider Name (Legal Business Name): CHILD AND ADOLESCENT MENTAL HEALTH PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
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 LN
SPARKS NV
89431-2809
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberE0133382012-2
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberE0133382012-2
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberE0133382012-2
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberE0133382012-2
License Number StateNV

VIII. Authorized Official

Name: MRS. TANJA FORD
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 775-331-8747