| Stephen Mayville A Professional Corporation | |
|
10631 Professional Cir Ste A Reno NV 89521-5835 | |
| (775) 826-6218 | |
| (775) 826-6271 |
| Full Name | Stephen Mayville A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 10631 Professional Cir Ste A, Reno, Nevada |
| Authorized Official Name and Position | Stephen Mayville (OWNER) |
| Authorized Official Contact | 7755602196 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen Mayville A Professional Corporation Po Box 70711 Reno NV 89570-0711 Ph: (775) 560-2196 | Stephen Mayville A Professional Corporation 10631 Professional Cir Ste A Reno NV 89521-5835 Ph: (775) 826-6218 |
| NPI Number | 1588289102 |
|---|---|
| Provider Enumeration Date | 06/09/2020 |
| Last Update Date | 07/27/2020 |
| Certification Date | 07/27/2020 |
| Medicare PECOS PAC ID | 7113343930 |
|---|---|
| Medicare Enrollment ID | O20200811002703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588289102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Stephen Mayville |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760582506 PECOS PAC ID: 0042243990 Enrollment ID: I20050913000135 |
| Provider Name | Jodi L Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750726717 PECOS PAC ID: 5799010708 Enrollment ID: I20190712002991 |
| Provider Name | Sarah J Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699017186 PECOS PAC ID: 6204254394 Enrollment ID: I20200922003161 |
| Provider Name | Rachel Lorraine Blinn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356823488 PECOS PAC ID: 1658772231 Enrollment ID: I20210722003545 |
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