Provider Demographics
NPI:1841793650
Name:NEVADA ELECTROMEDICAL PRODUCTS LLC
Entity Type:Organization
Organization Name:NEVADA ELECTROMEDICAL PRODUCTS LLC
Other - Org Name:CARSON VALLEY COUNSELING & NEUROTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-781-9767
Mailing Address - Street 1:1650 US HIGHWAY 395 N STE 201D
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4332
Mailing Address - Country:US
Mailing Address - Phone:775-781-9767
Mailing Address - Fax:775-265-1841
Practice Address - Street 1:1650 US HIGHWAY 395 N STE 201D
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4332
Practice Address - Country:US
Practice Address - Phone:775-781-9767
Practice Address - Fax:775-265-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5275-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty