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General NPI Number Information
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NPI Number | 1972501021
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Entity Type | Organization
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Legal Business Name | STATE OF NEVADA
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 480 GALLETTI WAY
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City | SPARKS
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State | NV
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Zip | 89431-5564
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Country | US
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Telephone | 775-688-0400
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Fax | 775-688-0434
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Provider Business Mailing Address
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Address Line | 4150 TECHNOLOGY WAY STE:300
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City | CARSON CITY
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State | NV
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Zip | 89706-2026
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Country | US
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Telephone | 775-684-4051
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Fax | 775-684-5966
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Authorized Official
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Title or Position | INTERIM AGENCY MANAGER
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Name | HELEN BYRD
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Credential | JD, LCSW
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Telephone | 775-688-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 652HOS-14
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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