Provider Demographics
NPI:1982873071
Name:MOUNTAIN EMPLOYEE ASSISTANCE PROGRAM
Entity type:Organization
Organization Name:MOUNTAIN EMPLOYEE ASSISTANCE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:EVARTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-322-6066
Mailing Address - Street 1:1091 HASKELL STREET
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-322-6066
Mailing Address - Fax:775-322-6566
Practice Address - Street 1:1091 HASKELL STREET
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-322-6066
Practice Address - Fax:775-322-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002616023Medicaid
NV002616023Medicaid
NVV36321Medicare PIN
NVV36320Medicare PIN