Healthcare Provider Details

I. General information

NPI: 1073816062
Provider Name (Legal Business Name): CHANTIL ALEE BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E HORIZON DR STE 140
HENDERSON NV
89015-8440
US

IV. Provider business mailing address

709 E HORIZON DR STE 140
HENDERSON NV
89015-8440
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-5379
  • Fax: 702-446-9253
Mailing address:
  • Phone: 702-763-5379
  • Fax: 702-466-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5238
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5238
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: