Provider Demographics
NPI:1992030068
Name:KORNAHRENS, STACY (MA MFT)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:
Last Name:KORNAHRENS
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 HASKELL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2815
Mailing Address - Country:US
Mailing Address - Phone:775-322-6066
Mailing Address - Fax:775-322-6566
Practice Address - Street 1:1091 HASKELL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-2815
Practice Address - Country:US
Practice Address - Phone:775-322-6066
Practice Address - Fax:775-322-6566
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist