| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 20 N Ada St, Fallon, Nevada |
| Authorized Official Name and Position | Jessica Homer (MANAGING MEMBER) |
| Authorized Official Contact | 7754269367 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2104 Fallon NV 89407-2104 Ph: (775) 426-9367 | 20 N Ada St Fallon NV 89406-2906 Ph: (775) 391-6088 |
| NPI Number | 1487393096 |
|---|---|
| Provider Enumeration Date | 06/01/2022 |
| Last Update Date | 07/05/2022 |
| Certification Date | 07/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487393096 | NPI | - | NPPES |
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