Provider Demographics
NPI:1144574708
Name:GAGNE, MELISSA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:GAGNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 VILLA EMO ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-7269
Mailing Address - Country:US
Mailing Address - Phone:402-980-0167
Mailing Address - Fax:
Practice Address - Street 1:2675 S JONES BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5607
Practice Address - Country:US
Practice Address - Phone:702-951-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8293-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical