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General NPI Number Information
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NPI Number | 1467287474
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Entity Type | Individual
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Provider Name | EZEKIEL HOWARD AMOSA VINSON
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Gender | Male
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 955 S VIRGINIA ST STE 212
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City | RENO
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State | NV
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Zip | 89502-2478
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Country | US
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Telephone | 775-346-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 251 E 224TH ST S
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City | ELY
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State | NV
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Zip | 89301-9630
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Country | US
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Telephone | 775-296-2506
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11721-M
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License Number State | NV
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