Healthcare Provider Details

I. General information

NPI: 1699699306
Provider Name (Legal Business Name): MICHELLE BALDOVINO ANDREWS MFT LICENSED INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N TENAYA WAY STE 200
LAS VEGAS NV
89128-0480
US

IV. Provider business mailing address

732 S 6TH ST STE R
LAS VEGAS NV
89101-6948
US

V. Phone/Fax

Practice location:
  • Phone: 702-757-8720
  • Fax:
Mailing address:
  • Phone: 702-406-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4802
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: