Basic Information
| Provider Information | |||||||||
| NPI: | 1598413254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | EBONY | ||||||||
| MiddleName: | MEDINA | ||||||||
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| Credential: | CSW-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 SANDIA DR | ||||||||
| Address2: | |||||||||
| City: | FERNLEY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894089623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752176148 | ||||||||
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| Practice Location | |||||||||
| Address1: | 890 MILL ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755386700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2022 | ||||||||
| LastUpdateDate: | 03/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | IC-1916 | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.