Provider Demographics
NPI:1710559398
Name:SIERRA DRAGONFLY CENTER LLC
Entity Type:Organization
Organization Name:SIERRA DRAGONFLY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CREATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-389-5433
Mailing Address - Street 1:1325 AIRMOTIVE WAY STE 140
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3283
Mailing Address - Country:US
Mailing Address - Phone:775-389-5433
Mailing Address - Fax:775-387-4845
Practice Address - Street 1:1325 AIRMOTIVE WAY STE 140
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3283
Practice Address - Country:US
Practice Address - Phone:775-389-5433
Practice Address - Fax:775-387-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty