Provider Demographics
NPI:1447798574
Name:RENGADE COUNSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:RENGADE COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LADC
Authorized Official - Phone:775-348-4900
Mailing Address - Street 1:527 HUMBOLDT STREET
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-348-4900
Mailing Address - Fax:774-348-4922
Practice Address - Street 1:527 HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1603
Practice Address - Country:US
Practice Address - Phone:775-348-4900
Practice Address - Fax:774-348-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151739907251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health