Healthcare Provider Details

I. General information

NPI: 1265050561
Provider Name (Legal Business Name): MELISSA L QUERRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 SAINT ROSE PKWY STE 302
HENDERSON NV
89074-7776
US

IV. Provider business mailing address

2470 SAINT ROSE PKWY STE 302
HENDERSON NV
89074-7776
US

V. Phone/Fax

Practice location:
  • Phone: 493-711-0809
  • Fax: 702-566-4575
Mailing address:
  • Phone: 493-711-0809
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MELISSA QUERRY
Title or Position: OWNER
Credential: LCSW
Phone: 949-371-1080