Basic Information
Provider Information
NPI: 1881052132
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIMA
FirstName: NIKOLAI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: 2355 SOLITUDE DR
Address2:  
City: RENO
State: NV
PostalCode: 895118191
CountryCode: US
TelephoneNumber: 5408408194
FaxNumber:  
Practice Location
Address1: 850 MILL ST STE 100
Address2:  
City: RENO
State: NV
PostalCode: 895021463
CountryCode: US
TelephoneNumber: 7755386700
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/02/2016
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X0205087556NVN    
101YM0800X0205087556NVY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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