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General NPI Number Information
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NPI Number | 1689227944
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Entity Type | Individual
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Provider Name | TANYA MARIE JOLLEY LCSW, ACM-SW
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Gender | Female
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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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 | 775-786-7200
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Fax | 775-326-2957
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Provider Business Mailing Address
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Address Line | 815 KILEY PKWY UNIT 702
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City | SPARKS
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State | NV
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Zip | 89436-4084
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Country | US
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Telephone | 570-371-1509
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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 | CW018279
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License Number State | PA
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