Provider Demographics
NPI:1245447267
Name:FAMILY COUNSELING SERVICE
Entity type:Organization
Organization Name:FAMILY COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-329-0623
Mailing Address - Street 1:575 E PLUMB LANE
Mailing Address - Street 2:STE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-329-0623
Mailing Address - Fax:775-337-2971
Practice Address - Street 1:575 E PLUMB LANE
Practice Address - Street 2:STE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
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:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PY218103T00000X
PY109103T00000X
4362C104100000X
01907S104100000X
2936S104100000X
4798S104100000X
4541C1041C0700X
2725C1041C0700X
4042C1041C0700X
0320106H00000X
0719106H00000X
0424106H00000X
0945106H00000X
90502084P0800X
102152084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WJBHHMedicare ID - Type UnspecifiedGROUP
40352Medicare ID - Type UnspecifiedKRISTIN HESTDALEN MD
PHD218Medicare ID - Type UnspecifiedSTEVE ROTH PHD
32417Medicare ID - Type UnspecifiedELLEN MCBRIDE MD
30859Medicare ID - Type UnspecifiedMARCIA HARRINGTON PHD