Individual
LISA FAVSTRITSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
40 E CENTER ST STE 12, FALLON, NV 89406-3474
(775) 867-5615
(775) 867-5616
Mailing address
625 S RUSSELL ST, FALLON, NV 89406-3722
(775) 217-4325
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/29/2014
Last updated
12/29/2014
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