Provider Demographics
NPI:1184954604
Name:STEPPING STONES YOUTH FACILITY
Entity type:Organization
Organization Name:STEPPING STONES YOUTH FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WACHSMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:775-423-1132
Mailing Address - Street 1:2101 AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-7142
Mailing Address - Country:US
Mailing Address - Phone:775-423-1132
Mailing Address - Fax:775-423-3503
Practice Address - Street 1:2101 AGENCY RD
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-7142
Practice Address - Country:US
Practice Address - Phone:775-423-1132
Practice Address - Fax:775-423-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY085103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty