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General NPI Number Information
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NPI Number | 1780394213
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Entity Type | Organization
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Legal Business Name | NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 595 BELL ST
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City | RENO
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State | NV
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Zip | 89503-4430
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Country | US
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Telephone | 775-786-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 580 W 5TH ST
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City | RENO
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State | NV
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Zip | 89503-4407
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Country | US
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Telephone | 775-997-7543
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DEBRA L DE VAY
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Credential |
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Telephone | 775-997-7579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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