Healthcare Provider Details

I. General information

NPI: 1346719754
Provider Name (Legal Business Name): MARY LOU ANCHETA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

IV. Provider business mailing address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-7321
  • Fax:
Mailing address:
  • Phone: 702-763-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1201
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: