Healthcare Provider Details

I. General information

NPI: 1245627496
Provider Name (Legal Business Name): JENNA MARIE DI LAURO M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WATER ST STE 200
HENDERSON NV
89015-7226
US

IV. Provider business mailing address

203 S WATER ST STE 200
HENDERSON NV
89015-7226
US

V. Phone/Fax

Practice location:
  • Phone: 702-983-0434
  • Fax: 702-906-1844
Mailing address:
  • Phone: 702-983-0434
  • Fax: 702-906-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01455
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: