Provider Demographics
NPI:1760604102
Name:BEITZ THOMPSON, KENDRA (PHD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BEITZ THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:BEITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5421 KIETZKE LN.
Mailing Address - Street 2:STE. 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3628
Mailing Address - Country:US
Mailing Address - Phone:775-852-3335
Mailing Address - Fax:775-828-7837
Practice Address - Street 1:5421 KIETZKE LN.
Practice Address - Street 2:STE. 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3628
Practice Address - Country:US
Practice Address - Phone:775-852-3335
Practice Address - Fax:775-828-7837
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical