Healthcare Provider Details

I. General information

NPI: 1770840936
Provider Name (Legal Business Name): MICHELLE KUNTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 S PECOS RD STE 17
LAS VEGAS NV
89121-5027
US

IV. Provider business mailing address

4160 S PECOS RD STE 17
LAS VEGAS NV
89121-5027
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-3484
  • Fax:
Mailing address:
  • Phone: 702-396-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07440-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: