Provider Demographics
NPI:1699083790
Name:THOMAS-MCDADE, REESE LAMOUNTE (BSW)
Entity type:Individual
Prefix:MR
First Name:REESE
Middle Name:LAMOUNTE
Last Name:THOMAS-MCDADE
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9627 GRAPELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4206
Mailing Address - Country:US
Mailing Address - Phone:702-738-3185
Mailing Address - Fax:
Practice Address - Street 1:9627 GRAPELAND AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4206
Practice Address - Country:US
Practice Address - Phone:702-738-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC201003303575251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005056203Medicaid