NPIMap

Organization Active NPI

Wilpsych Prof. LLC

  • Clinical Psychologist
  • Reno, NV
National Provider Identifier
1649019290
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
WILPSYCH PROF. LLC
Practice address
1350 Grand Summit Dr Apt 142
Reno, NV 89523-2558
Phone
(775) 561-0442
Fax
(775) 996-5208
NPI assigned
May 22, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marquez Ervin Wilson, PSYDNPI 1962162396
Title
Owner
Phone
(775) 561-0442

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

1350 Grand Summit Dr Apt 142
Reno, NV 89523-2558

Mailing address

1350 Grand Summit Dr Apt 142
Reno, NV 89523-2558
Phone (775) 561-0442

Other identifiers 1

IdentifierTypeStateIssuer
008640511OtherUNITED HEALTHCARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1649019290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 GRAND SUMMIT DR APT 142",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895232558",
            "telephone_number": "775-561-0442",
            "fax_number": "775-996-5208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 GRAND SUMMIT DR APT 142",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895232558",
            "telephone_number": "775-561-0442",
            "fax_number": "775-996-5208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILPSYCH PROF. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARQUEZ",
        "authorized_official_middle_name": "ERVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-561-0442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "008640511",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.