Healthcare Provider Details

I. General information

NPI: 1720517915
Provider Name (Legal Business Name): DEMI RAE TUUK VELARDE LMSW, CSW-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEMI RAE TUUK BA

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SPENCER ST STE 118
LAS VEGAS NV
89119-5250
US

IV. Provider business mailing address

3874 MANFORD CIR
LAS VEGAS NV
89104-5015
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-9710
  • Fax: 702-799-9712
Mailing address:
  • Phone: 702-488-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-2043
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: