Individual
LISA B DETTELBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
95 LA RUE AVE, RENO, NV 89509-2820
(775) 781-3760
Mailing address
2307 MILLVILLE DR, SPARKS, NV 89441-7319
(775) 781-3760
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4651
NV
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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