Provider Demographics
NPI:1669844395
Name:YASMER, PENNY (CADC-INTERN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:YASMER
Suffix:
Gender:F
Credentials:CADC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BIBLE WAY
Mailing Address - Street 2:SUITE 66
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-378-7535
Mailing Address - Fax:
Practice Address - Street 1:1000 BIBLE WAY
Practice Address - Street 2:SUITE 66
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-378-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01539-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)