Healthcare Provider Details

I. General information

NPI: 1982774402
Provider Name (Legal Business Name): LAURIE ROSE LYTEL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 W CRAIG RD SUITE 290
NORTH LAS VEGAS NV
89032-2508
US

IV. Provider business mailing address

9713 CRAIGHEAD LN
LAS VEGAS NV
89117-5929
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-5402
  • Fax: 702-486-5630
Mailing address:
  • Phone: 702-362-5626
  • Fax: 702-248-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01491-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: