Organization
CHILD AND ADOLESCENT MENTAL HEALTH PSYCHIATRIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANJA FORD (PROGRAM DIRECTOR)
(775) 331-8747
Entity
Organization
Contact information
Practice address
1055 ROBERTA LN, SPARKS, NV 89431-2809
(775) 331-8747
Mailing address
1055 ROBERTA LN, SPARKS, NV 89431-2809
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
E0133382012-2
NV
251S00000X
Community/Behavioral Health Agency
Primary
E0133382012-2
NV
252Y00000X
Early Intervention Provider Agency
E0133382012-2
NV
253Z00000X
In Home Supportive Care Agency
E0133382012-2
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E0133382012-2
—
NV
Enumeration date
07/08/2014
Last updated
07/08/2014
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