Provider Demographics
NPI:1144557489
Name:MINTEN, MARY (MA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MINTEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2411
Mailing Address - Country:US
Mailing Address - Phone:775-329-4582
Mailing Address - Fax:775-329-9943
Practice Address - Street 1:1005 FOREST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-2706
Practice Address - Country:US
Practice Address - Phone:775-329-4582
Practice Address - Fax:775-329-9943
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00446-I101YA0400X
NVM10068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)