Provider Demographics
NPI:1467287474
Name:VINSON, EZEKIEL HOWARD AMOSA
Entity type:Individual
Prefix:
First Name:EZEKIEL
Middle Name:HOWARD AMOSA
Last Name:VINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E 224TH ST S
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-9630
Mailing Address - Country:US
Mailing Address - Phone:775-296-2506
Mailing Address - Fax:
Practice Address - Street 1:955 S VIRGINIA ST STE 212
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2478
Practice Address - Country:US
Practice Address - Phone:775-346-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11721-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical