Provider Demographics
NPI:1376727016
Name:ELEY, CHARLENE P (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:P
Last Name:ELEY
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 1:1261 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-2903
Mailing Address - Country:US
Mailing Address - Phone:775-322-8906
Mailing Address - Fax:775-322-8906
Practice Address - Street 1:1261 E 9TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-2903
Practice Address - Country:US
Practice Address - Phone:775-322-8900
Practice Address - Fax:775-322-8906
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02428C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV35614Medicaid
NVP44998Medicare UPIN