Provider Demographics
NPI:1639502586
Name:HEALTHERAPY OF NEVADA
Entity type:Organization
Organization Name:HEALTHERAPY OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-824-0200
Mailing Address - Street 1:4600 KIETZKE LN
Mailing Address - Street 2:BUILDING A, SUITE 103
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5033
Mailing Address - Country:US
Mailing Address - Phone:775-824-0200
Mailing Address - Fax:
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:BUILDING A, SUITE 103
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-824-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHERAPY OF NEVADA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20071656876251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid