Provider Demographics
NPI:1962534321
Name:REILLY, LYNNE F (MFT LADC)
Entity type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:F
Last Name:REILLY
Suffix:
Gender:F
Credentials:MFT LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 GERALDINE DR
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451-8608
Mailing Address - Country:US
Mailing Address - Phone:775-527-5653
Mailing Address - Fax:775-833-1718
Practice Address - Street 1:781 GERALDINE DR
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8608
Practice Address - Country:US
Practice Address - Phone:775-527-5653
Practice Address - Fax:775-833-1719
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1088101YA0400X
NV0927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)