Provider Demographics
NPI:1861655938
Name:AGAPE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:AGAPE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEMENWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-322-4003
Mailing Address - Street 1:210 MARSH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1647
Mailing Address - Country:US
Mailing Address - Phone:775-322-4003
Mailing Address - Fax:775-322-4017
Practice Address - Street 1:210 MARSH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1647
Practice Address - Country:US
Practice Address - Phone:775-322-4003
Practice Address - Fax:775-322-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103TC0700X103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty