Provider Demographics
NPI:1144272139
Name:LIBLER, SHANNON LEE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEE
Last Name:LIBLER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 RIVER FRONT DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-8952
Mailing Address - Country:US
Mailing Address - Phone:775-747-6751
Mailing Address - Fax:
Practice Address - Street 1:10405 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-827-2400
Practice Address - Fax:775-827-2488
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3007-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184029464OtherGROUP NPI
NV100507630Medicaid
NV100507630Medicaid