MEDICARE: MS. HEIDI HANUSA MA LMFT

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	R07042	NV
2	101YM0800X	Mental Health Counselor	R07042

General Provider Information

NPI Number	:	1780830091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI HANUSA MA LMFT

Provider Business Mailing Address
First Line	:	1016 MONTICELLO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3735
Country	:	US
Telephone Number	:	702-370-4244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 MONTICELLO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3735
Country	:	US
Telephone Number	:	702-877-0036
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	02/08/2021

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