Unknown Individual – Marriage & Family Therapist, NPI 1023173887

Unknown Individual is a healthcare provider. based in Carson city, Nevada. specializing in MARRIAGE AND FAMILY THERAPIST. They hold a License No. 00158-L (NV). The NPI Number for Unknown Individual is 1023173887

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1023173887
Phone
(775) 885-7717
Address
2874 N CARSON ST
Deactivation Date
9 April 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7758857717
Graduation Year
2004 (22 years ago)
PAC ID
9931530169
Group Practice PAC ID
6204267420
Professional Enrollment ID
I20240326003417
Address ID
NV897031570CA844XXLNXX403
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

228 MARRIAGE AND FAMILY THERAPIST in NV

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Provider Addresses for Unknown Individual

  • Eagle Medical Center, 2874, North Carson Street, Carson City, Nevada, 89706, United States

    STE 215

    CARSON CITY, NV 897060177

    Phone: (775) 885-7717

    Fax: (775) 283-0231

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240326003417IMarriage And Family TherapistNVTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 89706)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6204267420View full group profile
NameSpecialtyState
Clinical PsychologistNV
Mental Health CounselorFL
Clinical Social WorkerNV

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1023173887.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Marriage & Family Therapist. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Carson City, Nevada?
For routing, start with Carson City, Nevada for Unknown Individual, then verify phone and hours locally.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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