Provider Demographics
NPI:1740076744
Name:TRIBBLE, KELLY (MSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TRIBBLE
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 S EASTERN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5576
Mailing Address - Country:US
Mailing Address - Phone:702-751-5055
Mailing Address - Fax:702-552-7138
Practice Address - Street 1:11500 S EASTERN AVE STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5576
Practice Address - Country:US
Practice Address - Phone:702-751-5055
Practice Address - Fax:702-552-7138
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6632-M1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool