Provider Demographics
NPI:1093169229
Name:MITTERMAYR, ENGELBERT (CRC,LAC,LMHCA,CPCI)
Entity Type:Individual
Prefix:
First Name:ENGELBERT
Middle Name:
Last Name:MITTERMAYR
Suffix:
Gender:M
Credentials:CRC,LAC,LMHCA,CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N CARSON ST STE 45
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1216
Mailing Address - Country:US
Mailing Address - Phone:775-775-4716
Mailing Address - Fax:
Practice Address - Street 1:100 N HOWARD ST STE W
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:775-741-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0373101YM0800X
AZLAC-16020101YP2500X
WAMC61476666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional