Healthcare Provider Details

I. General information

NPI: 1982115507
Provider Name (Legal Business Name): AMY REHA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E CARSON ST
VIRGINIA CITY NV
89440
US

IV. Provider business mailing address

PO BOX 980
VIRGINIA CITY NV
89440-0980
US

V. Phone/Fax

Practice location:
  • Phone: 775-847-9311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP5103
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: