Provider Demographics
NPI:1922760222
Name:STEENERSON, DALLYN SCOTT (LCSW)
Entity Type:Individual
Prefix:
First Name:DALLYN
Middle Name:SCOTT
Last Name:STEENERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 SUTTON WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-4207
Mailing Address - Country:US
Mailing Address - Phone:910-795-7604
Mailing Address - Fax:
Practice Address - Street 1:7291 W CHARLESTON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1596
Practice Address - Country:US
Practice Address - Phone:910-795-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11391-C1041C0700X
UT124072073502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker