Provider Demographics
NPI:1043662968
Name:MCDERMOTT, CHRISTIE (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:LYNN
Other - Last Name:KINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 WATERTON LAKES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2809
Mailing Address - Country:US
Mailing Address - Phone:509-939-0204
Mailing Address - Fax:
Practice Address - Street 1:8678 SPRING MOUNTAIN RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4103
Practice Address - Country:US
Practice Address - Phone:509-939-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60845527101YM0800X
NVCP0305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health