Provider Demographics
NPI:1063850683
Name:DESMOND, SHANTELL MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHANTELL
Middle Name:MARIE
Last Name:DESMOND
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 S MCCARRAN BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6129
Mailing Address - Country:US
Mailing Address - Phone:775-624-8200
Mailing Address - Fax:
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4967106H00000X
NVMI2824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist