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NPI Code Detail

MEDICARE: LISA A DURETTE MD PLLC

MEDICARE: LISA A DURETTE MD PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2101YM0800XMental Health Counselor
3101YA0400XAddiction (Substance Use Disorder) Counselor
4103T00000XPsychologist
52084P0800XPsychiatry Physician
6106H00000XMarriage & Family Therapist
7261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235633421
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISA A DURETTE MD PLLC
Provider Business Mailing Address
First Line : 840 S RANCHO DR # 4-337
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3837
Country : US
Telephone Number : 702-440-8440
Fax Number : 866-518-0781
Provider Business Practice Location Address
First Line : 526 S TONOPAH DR STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4013
Country : US
Telephone Number : 702-440-8440
Fax Number : 866-518-0781
Authorized Official
Title or Position : CEO
Name : KENNETH MCKAY
Credential : PH.D.
Telephone Number : 702-419-8920
Provider Enumeration Date : 03/21/2018
Last Update Date : 12/12/2025

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