Organization Name: | SEQUEL ALLIANCE FAMILY SERVICES, LLC |
NPI Number: | 1659793206 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY CAUDLE (CBO DIRECTOR OF PATIENT ACCOUNTS) |
Mailing Address: | 186 E Main St Ste 4 Fernley |
State: | NV US |
Postal Code: | 894087717 |
Phone Number: | 7755759889 |
Fax Number: | 7755759890 |
NPI Enumeration Date: | 01/16/2014 |
NPI Last Update Date: | 01/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | NV20141007166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |