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General NPI Number Information
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NPI Number | 1972684355
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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 | 10/18/2006
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 1538 HWY 395 N STE 100
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City | GARDNERVILLE
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State | NV
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Zip | 89410-5265
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Country | US
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Telephone | 775-687-2160
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Fax | 775-782-6639
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Provider Business Mailing Address
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Address Line | ATTN: CYNDI SMITH 240 S. HUMAHUACA
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City | PAHRUMP
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State | NV
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Zip | 89048-2199
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Country | US
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Telephone | 775-751-7406
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Fax | 775-751-7409
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Authorized Official
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Title or Position | AGENCY MANAGER
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Name | ELLE RICHARDSON-ADAMS
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Credential |
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Telephone | 702-486-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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