Provider Demographics
NPI:1235998279
Name:MENDED WING THERAPY
Entity Type:Organization
Organization Name:MENDED WING THERAPY
Other - Org Name:TRANSCEND THERAPY RENO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:775-233-6789
Mailing Address - Street 1:9721 OAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6160
Mailing Address - Country:US
Mailing Address - Phone:775-233-6789
Mailing Address - Fax:
Practice Address - Street 1:1005 FOREST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-2706
Practice Address - Country:US
Practice Address - Phone:775-233-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELACRUZ WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)