Provider Demographics
NPI:1922486141
Name:FAMILY COUNSELING SERVICE OF NORTHERN NEVADA
Entity Type:Organization
Organization Name:FAMILY COUNSELING SERVICE OF NORTHERN NEVADA
Other - Org Name:FAMILY COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW, LADC
Authorized Official - Phone:775-329-0623
Mailing Address - Street 1:575 E PLUMB LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3540
Mailing Address - Country:US
Mailing Address - Phone:775-329-0623
Mailing Address - Fax:775-337-2971
Practice Address - Street 1:575 E PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3540
Practice Address - Country:US
Practice Address - Phone:775-329-0623
Practice Address - Fax:775-337-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245447267Medicaid