Provider Demographics
NPI:1467727628
Name:AMBERCREEK COUNSELING & RECOVERY SERVICES
Entity Type:Organization
Organization Name:AMBERCREEK COUNSELING & RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT-I
Authorized Official - Phone:775-657-6644
Mailing Address - Street 1:219 REDFIELD PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6583
Mailing Address - Country:US
Mailing Address - Phone:775-657-6644
Mailing Address - Fax:775-654-6643
Practice Address - Street 1:219 REDFIELD PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6583
Practice Address - Country:US
Practice Address - Phone:775-657-6644
Practice Address - Fax:775-654-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0158106H00000X
NVM01168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty