NPIMap

Organization Active NPI

Lisa a Durette MD PLLC

  • Child & Adolescent Psychiatry Physician
  • Las Vegas, NV
National Provider Identifier
1669679205
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
LISA A DURETTE MD PLLC
Practice address
6600 W Charleston Blvd Ste 140
Las Vegas, NV 89146-1067
Phone
(702) 359-9404
Fax
(866) 518-0781
NPI assigned
Jun 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth McKay, PH.D.
Title
Ceo
Phone
(702) 419-8920

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

6600 W Charleston Blvd Ste 140
Las Vegas, NV 89146-1067

Mailing address

840 S Rancho Dr Ste 4-337
Las Vegas, NV 89106-3837
Phone (702) 440-8840

Other practice location 1

526 S Tonopah Dr Ste 200
Las Vegas, NV 89106-4013
Phone (702) 440-8440

Other practice location 2

7291 W Charleston Blvd Ste 120
Las Vegas, NV 89117-1596
Phone (725) 237-0080

Other identifiers 1

IdentifierTypeStateIssuer
1669679205MedicaidNV

Other names 1

  • Healthy Minds Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070719000161 NV Part B Supplier - Clinic/Group Practice 6103927280 Receives reassigned benefits from 37 practitioners
1 other NPI on this enrollment
Practice locations: Las Vegas, NV

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lisa a Durette MD LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6600 W Charleston Blvd
Ste 140
Las Vegas, NV 89146
Phone (702) 440-8440

552 E Charleston Blvd
Las Vegas, NV 89104
Phone (702) 440-8440

Practitioners & affiliated clinicians

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 58

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1669679205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S RANCHO DR STE 4-337",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891063837",
            "telephone_number": "702-440-8840",
            "fax_number": "866-518-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 W CHARLESTON BLVD STE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461067",
            "telephone_number": "702-359-9404",
            "fax_number": "866-518-0781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "526 S Tonopah Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891064013",
            "country_code": "US",
            "telephone_number": "702-440-8440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7291 W Charleston Blvd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891171596",
            "country_code": "US",
            "telephone_number": "725-237-0080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LISA A DURETTE MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "MCKAY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "702-419-8920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669679205",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthy Minds",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthy Minds",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.