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General NPI Number Information
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NPI Number | 1558805192
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Entity Type | Individual
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Provider Name | PHILLIP BRADLEY BOEYE LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 975 KIRMAN AVE
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City | RENO
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State | NV
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Zip | 89502-0993
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Country | US
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Telephone | 775-326-2932
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Fax |
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Provider Business Mailing Address
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Address Line | 17000 WEDGE PKWY UNIT 2325
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City | RENO
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State | NV
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Zip | 89511-3243
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Country | US
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Telephone | 385-988-0875
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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 | 21174
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License Number State | MD
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