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General NPI Number Information
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NPI Number | 1356963144
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Entity Type | Individual
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Provider Name | JEANINE SERUSA LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/14/2020
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 620 E PLUMB LN
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City | RENO
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State | NV
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Zip | 89502-3536
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Country | US
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Telephone | 775-622-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 17853 DAVIS MEADOW CT
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City | RENO
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State | NV
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Zip | 89508-6811
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Country | US
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Telephone | 775-622-6450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 06596-C
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MI4098
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License Number State | NV
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