Basic Information
| Provider Information | |||||||||
| NPI: | 1457095648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEMIS | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | LEEANN | ||||||||
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| Credential: | LMSW, CSW-INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 FLEISCHMANN WAY | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897032995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 775 FLEISCHMANN WAY | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897032995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457756 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2022 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 5473-M | NV | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | IC-1948 | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.