Provider Demographics
NPI:1013563915
Name:MISANKO, DESIREE LYNNE (MA)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:LYNNE
Last Name:MISANKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 OLD HOT SPRINGS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0668
Mailing Address - Country:US
Mailing Address - Phone:775-687-0894
Mailing Address - Fax:
Practice Address - Street 1:1665 OLD HOT SPRINGS RD STE 150
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0668
Practice Address - Country:US
Practice Address - Phone:775-687-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health