Provider Demographics
NPI:1043660483
Name:PORTILLO, MARGARITA (BSW)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:PORTILLO
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89432-0249
Mailing Address - Country:US
Mailing Address - Phone:775-857-6007
Mailing Address - Fax:
Practice Address - Street 1:6590 S MCCARRAN BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6171
Practice Address - Country:US
Practice Address - Phone:775-857-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor