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General NPI Number Information
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NPI Number | 1023490794
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Entity Type | Organization
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Legal Business Name | CENTRAL LYON YOUTH CONNECTIONS
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 170 PIKE STREET
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City | DAYTON
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State | NV
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Zip | 89403
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Country | US
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Telephone | 775-246-0320
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Fax | 775-246-7553
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Provider Business Mailing Address
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Address Line | P.O. BOX 1865
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City | DAYTON
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State | NV
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Zip | 89403
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Country | US
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Telephone | 775-246-0320
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, LCSW
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Name | MICHELE ANN WATKINS
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Credential | MSW
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Telephone | 775-246-0320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6731-C
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License Number State | NV
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