MEDICARE: STACY S DEPRIEST LCSW

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
1	1041C0700X	Clinical Social Worker	2435-C	NV

General Provider Information

NPI Number	:	1841508983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY S DEPRIEST LCSW

Provider Business Mailing Address
First Line	:	PO BOX 82130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-2130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 S TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1528
Country	:	US
Telephone Number	:	702-340-8008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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Directions to “ STACY S DEPRIEST LCSW” Practice Location

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