Provider Demographics
NPI:1154506459
Name:MEBANE, LO'RECE L (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LO'RECE
Middle Name:L
Last Name:MEBANE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 S JONES BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6793
Mailing Address - Country:US
Mailing Address - Phone:702-749-6926
Mailing Address - Fax:702-272-2011
Practice Address - Street 1:3030 S JONES BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6793
Practice Address - Country:US
Practice Address - Phone:702-749-6926
Practice Address - Fax:702-272-2011
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3017-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical