Provider Demographics
NPI:1952794281
Name:FAMILY SUPPORT COUNCIL OF DOUGLAS COUNTY
Entity Type:Organization
Organization Name:FAMILY SUPPORT COUNCIL OF DOUGLAS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-782-8692
Mailing Address - Street 1:1255 WATERLOO LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-7403
Mailing Address - Country:US
Mailing Address - Phone:775-782-8692
Mailing Address - Fax:775-782-1942
Practice Address - Street 1:1255 WATERLOO LN
Practice Address - Street 2:SUITE A
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-7403
Practice Address - Country:US
Practice Address - Phone:775-782-8692
Practice Address - Fax:775-782-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV19821006005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty