Healthcare Provider Details

I. General information

NPI: 1891027876
Provider Name (Legal Business Name): LESLIE MARIE RANGEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LAMOILLE HWY STE 310
ELKO NV
89801-4397
US

IV. Provider business mailing address

681 DRY CREEK TRL
ELKO NV
89801-1214
US

V. Phone/Fax

Practice location:
  • Phone: 702-271-3942
  • Fax:
Mailing address:
  • Phone: 702-271-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7121-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: