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General NPI Number Information
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NPI Number | 1194959262
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Entity Type | Organization
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Legal Business Name | RENO VET CENTER
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 05/05/2009
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Provider Practice Location Address
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Address Line | 1155 W. 4TH ST. #101
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City | RENO
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State | NV
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Zip | 89403
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Country | US
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Telephone | 775-323-1294
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Fax | 775-322-8123
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Provider Business Mailing Address
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Address Line | 1155 W 4TH ST STE 101 SUITE #101
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City | RENO
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State | NV
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Zip | 89503-5146
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Country | US
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Telephone | 775-323-1294
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Fax | 775-322-8123
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Authorized Official
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Title or Position | TEAM LEADER
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Name | MR. SCOTT DREW
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Credential | MFT
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Telephone | 775-323-1294
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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 | LCSW-13608
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW-4536-C
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License Number State | NV
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