Healthcare Provider Details

I. General information

NPI: 1497092720
Provider Name (Legal Business Name): CARRIE LEE DYE GENE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE COPELAND

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 S MARYLAND PKWY
LAS VEGAS NV
89109-2412
US

IV. Provider business mailing address

3247 S MARYLAND PKWY
LAS VEGAS NV
89109-2412
US

V. Phone/Fax

Practice location:
  • Phone: 702-776-3500
  • Fax:
Mailing address:
  • Phone: 702-776-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8071-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: