Provider Demographics
NPI:1225766892
Name:BERNAIX, DALLIS (MFT-I)
Entity Type:Individual
Prefix:
First Name:DALLIS
Middle Name:
Last Name:BERNAIX
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:DALLIS
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8855
Mailing Address - Country:US
Mailing Address - Phone:360-356-5594
Mailing Address - Fax:
Practice Address - Street 1:770 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1321
Practice Address - Country:US
Practice Address - Phone:775-636-7767
Practice Address - Fax:702-830-9741
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist