Healthcare Provider Details

I. General information

NPI: 1891233755
Provider Name (Legal Business Name): ALLISON KELLY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S WELLS AVE
RENO NV
89502-2550
US

IV. Provider business mailing address

1434 ROSY FINCH DR
SPARKS NV
89441-7876
US

V. Phone/Fax

Practice location:
  • Phone: 775-336-3700
  • Fax:
Mailing address:
  • Phone: 775-313-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5638-S
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-1245
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: