Basic Information
| Provider Information | |||||||||
| NPI: | 1164069597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLETT | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | LSW, CSW-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 HELVETIA AVE | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134580519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 KIRMAN AVE | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757867200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2019 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 8224-S | NV | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.