Provider Demographics
NPI:1417410358
Name:GUANTONIO, MISTY (MFT, LCDAC-INTERN)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:GUANTONIO
Suffix:
Gender:F
Credentials:MFT, LCDAC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 US HIGHWAY 395 N STE 103
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4331
Mailing Address - Country:US
Mailing Address - Phone:775-237-8020
Mailing Address - Fax:
Practice Address - Street 1:1650 US HIGHWAY 395 N STE 103
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4331
Practice Address - Country:US
Practice Address - Phone:775-237-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4111106H00000X
NV00347-LCINTERN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)