MEDICARE: MR. MICHAEL ANTHONY GUYNN MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518679091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY GUYNN MA

Provider Business Mailing Address
First Line	:	PO BOX 432045
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-8645
Country	:	US
Telephone Number	:	323-972-4374
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 N MLK BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0299
Country	:	US
Telephone Number	:	702-485-1313
Fax Number	:

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

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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