Healthcare Provider Details

I. General information

NPI: 1417410358
Provider Name (Legal Business Name): MISTY GUANTONIO MFT, LCDAC-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LUCERNE ST STE 205
MINDEN NV
89423-4312
US

IV. Provider business mailing address

1650 LUCERNE ST STE 205
MINDEN NV
89423-4312
US

V. Phone/Fax

Practice location:
  • Phone: 775-237-8020
  • Fax: 775-298-6600
Mailing address:
  • Phone: 775-237-8020
  • Fax: 775-298-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07204-LC
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4111
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: