Healthcare Provider Details

I. General information

NPI: 1205200052
Provider Name (Legal Business Name): HAZEL MAY REYES GUENTHER LMFT-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD STE 140
LAS VEGAS NV
89146-1067
US

IV. Provider business mailing address

6626 BRISTLE FALLS ST
LAS VEGAS NV
89149-1320
US

V. Phone/Fax

Practice location:
  • Phone: 702-265-8121
  • Fax:
Mailing address:
  • Phone: 702-265-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI0746
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMI0746
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: