MEDICARE: MISTY GUANTONIO MFT, LCDAC-INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4111	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	07204-LC	NV

General Provider Information

NPI Number	:	1417410358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY GUANTONIO MFT, LCDAC-INTERN

Provider Business Mailing Address
First Line	:	1650 LUCERNE ST STE 205
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-4312
Country	:	US
Telephone Number	:	775-237-8020
Fax Number	:	775-298-6600

Provider Business Practice Location Address
First Line	:	1650 LUCERNE ST STE 205
Second Line	:
City	:	MINDEN
State	:	NV
Zip	:	89423-4312
Country	:	US
Telephone Number	:	775-237-8020
Fax Number	:	775-298-6600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	02/13/2026

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