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NPI Code Detail

MEDICARE: JAMES W DISS PSY.D.

MEDICARE: JAMES W DISS PSY.D.
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
1103T00000XPsychologistPY0446NV

General Provider Information

NPI Number : 1811903180
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES W DISS PSY.D.
Provider Business Mailing Address
First Line : 480 GALLETTI WAY
Second Line :
City : SPARKS
State : NV
Zip : 89431-5564
Country : US
Telephone Number : 775-688-2001
Fax Number : 775-688-2192
Provider Business Practice Location Address
First Line : 480 GALLETTI WAY
Second Line :
City : SPARKS
State : NV
Zip : 89431-5564
Country : US
Telephone Number : 775-688-2001
Fax Number : 775-688-2192
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/08/2007

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