MEDICARE: GRACE COMMUNITY CHURCH OF RENO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1124864186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE COMMUNITY CHURCH OF RENO

Provider Business Mailing Address
First Line	:	6180 MAE ANNE AVE STE 5
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-4708
Country	:	US
Telephone Number	:	775-525-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	6180 MAE ANNE AVE STE 5
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89523-4708
Country	:	US
Telephone Number	:	775-525-8010
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KELLI SINGLETON
Credential	:
Telephone Number	:	775-525-8020

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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Directions to “GRACE COMMUNITY CHURCH OF RENO ” Practice Location

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