Provider Demographics
NPI:1093073132
Name:WISKERCHEN, JACOB RICHARD JR (MFT, NCC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:RICHARD
Last Name:WISKERCHEN
Suffix:JR
Gender:M
Credentials:MFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CHENEY ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0912
Mailing Address - Country:US
Mailing Address - Phone:775-287-1099
Mailing Address - Fax:
Practice Address - Street 1:418 CHENEY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0912
Practice Address - Country:US
Practice Address - Phone:775-525-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01270106H00000X
NVMI0340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist