Provider Demographics
NPI:1275940918
Name:FESENMAIER, MALAINA
Entity Type:Individual
Prefix:
First Name:MALAINA
Middle Name:
Last Name:FESENMAIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2834
Mailing Address - Country:US
Mailing Address - Phone:775-934-0394
Mailing Address - Fax:
Practice Address - Street 1:1825 PINION RD STE A
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8319
Practice Address - Country:US
Practice Address - Phone:775-728-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-1435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health