=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356777437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESIREE SMITH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2013
-----------------------------------------------------
Last Update Date | 03/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1159 RANCHO MIRAGE DR
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-8106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-234-8523
-----------------------------------------------------
Fax | 775-260-0261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1344 DISC DR # 1024
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-0684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-234-8523
-----------------------------------------------------
Fax | 775-624-9795
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | IC-1272
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 9673-C
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------