Provider Demographics
NPI:1225332265
Name:BUCKLES, SHELBY S (MSW LSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:S
Last Name:BUCKLES
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:MISS
Other - First Name:SHELBY
Other - Middle Name:S
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4285 N RANCHO DR
Mailing Address - Street 2:130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3446
Mailing Address - Country:US
Mailing Address - Phone:702-385-5331
Mailing Address - Fax:702-385-5678
Practice Address - Street 1:4285 N RANCHO DR
Practice Address - Street 2:130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3446
Practice Address - Country:US
Practice Address - Phone:702-385-5331
Practice Address - Fax:702-385-5678
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5356-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker