Provider Information for 1508343484
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PHYLLIS ANNE TRAIL RN, LMFT
Sex: Female
NPI: 1508343484
Last Updated: 2018-07-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1508343484 | ||||||||||||
| Enumeration Date | 2018-07-24 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 4521 CARSON CITY, NV 89702-4521 United States Phone: 775-888-9148 | Fax: | ||||||||||||
| Primary Practice Address | 850 MILL ST STE 100 RENO, NV 89502-1463 United States Phone: 775-538-6700 | Fax:775-688-5878 | ||||||||||||
| Secondary Practice Address(es) | 3105 CHUBASCO WAY | ||||||||||||
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