Basic Information
| Provider Information | |||||||||
| NPI: | 1801334255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEQUEL ALLIANCE FAMILY SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1131 EAGLETREE LN SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568803339 | ||||||||
| FaxNumber: | 2568809569 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 W MOANA LN | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753372394 | ||||||||
| FaxNumber: | 7753379570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2017 | ||||||||
| LastUpdateDate: | 07/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | MORASKY | ||||||||
| AuthorizedOfficialFirstName: | RACHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7753372394 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NV20141007166 | NV | N | Agencies | Community/Behavioral Health | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.