Basic Information
| Provider Information | |||||||||
| NPI: | 1831342617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEAL THERAPY OF NEVADA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 N ROOP ST | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897014778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758849911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 N ROOP ST | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758849911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2008 | ||||||||
| LastUpdateDate: | 10/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | PINDELL | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7758849911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW 24336 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | IC-509 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1124219712 | 01 | NV | MEDICAID PROVIDER GROUP NPI | OTHER |