Healthcare Provider Details

I. General information

NPI: 1760653224
Provider Name (Legal Business Name): SHIRLEY LUCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 EDISON WAY
RENO NV
89502-4100
US

IV. Provider business mailing address

650 EDISON WAY
RENO NV
89502-4100
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-4717
  • Fax: 775-284-4595
Mailing address:
  • Phone: 775-284-4717
  • Fax: 775-284-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4836-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: