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General NPI Number Information
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NPI Number | 1760950638
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Entity Type | Organization
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Legal Business Name | A WISER MIND NEVADA LLC
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 11/08/2018
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Provider Practice Location Address
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Address Line | 401 RYLAND ST STE 200A
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City | RENO
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State | NV
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Zip | 89502-1643
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Country | US
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Telephone | 775-571-1616
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Fax | 877-926-0262
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Provider Business Mailing Address
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Address Line | 6000 E EVANS AVE STE 3-100
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City | DENVER
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State | CO
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Zip | 80222-5422
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Country | US
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Telephone | 720-940-8531
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Fax | 720-378-5034
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Authorized Official
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Title or Position | DIRECTOR OF BILLING
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Name | ABIGAIL KNOPER
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Credential |
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Telephone | 720-940-8531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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