Provider Demographics
NPI:1952753410
Name:LEEANNE HEMENWAY PHD PROF LLC
Entity type:Organization
Organization Name:LEEANNE HEMENWAY PHD PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-221-3281
Mailing Address - Street 1:625 EUREKA AVE
Mailing Address - Street 2:#A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3457
Mailing Address - Country:US
Mailing Address - Phone:775-221-3281
Mailing Address - Fax:
Practice Address - Street 1:210 MARSH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1647
Practice Address - Country:US
Practice Address - Phone:775-336-9762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0736251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0660OtherMFT LICENSE
NVPY0736OtherPSYCHOLOGY LICENSE