Healthcare Provider Details

I. General information

NPI: 1730813361
Provider Name (Legal Business Name): JACQUELINE BUZANIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 N GREEN VALLEY PKWY STE 100
HENDERSON NV
89074-1606
US

IV. Provider business mailing address

1915 N GREEN VALLEY PKWY STE 100
HENDERSON NV
89074-1606
US

V. Phone/Fax

Practice location:
  • Phone: 702-816-7836
  • Fax: 702-472-8877
Mailing address:
  • Phone: 702-816-7836
  • Fax: 702-472-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4598
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: