=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982873071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN EMPLOYEE ASSISTANCE PROGRAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2008
-----------------------------------------------------
Last Update Date | 09/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1091 HASKELL STREET
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-6066
-----------------------------------------------------
Fax | 775-322-6566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1091 HASKELL STREET
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-322-6066
-----------------------------------------------------
Fax | 775-322-6566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, CLINICAL DIRECTOR
-----------------------------------------------------
Name | FRANK EVARTS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 775-322-6066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY044
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------