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General NPI Number Information
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NPI Number | 1376368381
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Entity Type | Organization
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Legal Business Name | SERENITY ROAD COUNSELING LLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1775 BROWNING WAY STE 102
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City | ELKO
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State | NV
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Zip | 89801-8338
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Country | US
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Telephone | 775-388-9851
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Fax | 775-204-2202
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Provider Business Mailing Address
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Address Line | PO BOX 592
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City | CARLIN
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State | NV
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Zip | 89822-0592
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Country | US
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Telephone | 775-388-9851
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Fax | 775-204-2202
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. JANICE M BRIZEE JOHNSTON
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Credential | LCSW
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Telephone | 775-388-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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