Provider Demographics
NPI:1679780100
Name:DE SELLE, SCOTT E (LCSW)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:DE SELLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10680 CEDAR BEND CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8204
Mailing Address - Country:US
Mailing Address - Phone:775-200-8528
Mailing Address - Fax:775-800-1551
Practice Address - Street 1:85 KEYSTONE AVE
Practice Address - Street 2:STE F
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5571
Practice Address - Country:US
Practice Address - Phone:775-200-8528
Practice Address - Fax:775-800-1551
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5176-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical