Provider Demographics
NPI:1063607711
Name:GREAT BASIN COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:GREAT BASIN COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-827-4454
Mailing Address - Street 1:PO BOX 3076
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-3076
Mailing Address - Country:US
Mailing Address - Phone:775-827-4454
Mailing Address - Fax:775-827-1707
Practice Address - Street 1:525 ROBERTS ST STE 102
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-7814
Practice Address - Country:US
Practice Address - Phone:775-827-4454
Practice Address - Fax:775-827-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0393-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty