1861746182 NPI number — MISS AMBER MARIE SUNDLAND LCSW

Table of content: MADISON EVANS (NPI 1447913645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861746182 NPI number — MISS AMBER MARIE SUNDLAND LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDLAND
Provider First Name:
AMBER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLER
Provider Other First Name:
AMBER
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861746182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9460 DOUBLE R BLVD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89521-6020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-284-8650
Provider Business Mailing Address Fax Number:
775-432-2339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5578 LONGLEY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89511-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-284-8650
Provider Business Practice Location Address Fax Number:
775-284-8654
Provider Enumeration Date:
11/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6821-C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com