=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366876161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAYTON VALLEY FAMILY THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2013
-----------------------------------------------------
Last Update Date | 08/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 DAYTON VALLEY RD SUITE 102-A
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89403-8923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-461-2094
-----------------------------------------------------
Fax | 775-246-0851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 DAYTON VALLEY RD SUITE 102-A
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89403-8923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-461-2094
-----------------------------------------------------
Fax | 775-246-0851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | JOEY LORRAINE PARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-461-2094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MI0435
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------