Provider Demographics
NPI:1376969147
Name:SILVER STATE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:SILVER STATE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-420-9926
Mailing Address - Street 1:2470 WRONDEL WAY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3701
Mailing Address - Country:US
Mailing Address - Phone:775-420-9926
Mailing Address - Fax:775-284-0685
Practice Address - Street 1:2470 WRONDEL WAY
Practice Address - Street 2:SUITE 260
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3701
Practice Address - Country:US
Practice Address - Phone:775-420-9926
Practice Address - Fax:775-284-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty