Provider Demographics
NPI:1356777437
Name:SMITH, DESIREE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, MSW, LSW
Mailing Address - Street 1:1344 DISC DR # 1024
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0684
Mailing Address - Country:US
Mailing Address - Phone:775-234-8523
Mailing Address - Fax:775-624-9795
Practice Address - Street 1:1159 RANCHO MIRAGE DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8106
Practice Address - Country:US
Practice Address - Phone:775-234-8523
Practice Address - Fax:775-260-0261
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-1272101Y00000X
NV9673-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356777437Medicaid