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General NPI Number Information
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NPI Number | 1508279746
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Entity Type | Organization
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Legal Business Name | EDWARDS AND VON RAVENSBERG, PROF. LLC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 12/06/2015
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Provider Practice Location Address
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Address Line | 1325 AIRMOTIVE WAY STE 100
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City | RENO
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State | NV
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Zip | 89502-3201
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Country | US
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Telephone | 775-453-4143
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Fax | 775-996-5616
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Provider Business Mailing Address
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Address Line | 1325 AIRMOTIVE WAY STE 100
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City | RENO
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State | NV
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Zip | 89502-3201
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Country | US
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Telephone | 775-453-4143
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Fax | 775-996-5616
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | RUDOLPH VON RAVENSBERG
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Credential | MA
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Telephone | 775-453-4143
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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 | NV MFT 1098
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License Number State | NV
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