Provider Demographics
NPI:1538676622
Name:HOWARD, MATZYONNA CHARLYNN (COUNSLER ,)
Entity Type:Individual
Prefix:
First Name:MATZYONNA
Middle Name:CHARLYNN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:COUNSLER ,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N RAINBOW BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1189
Mailing Address - Country:US
Mailing Address - Phone:702-948-7602
Mailing Address - Fax:702-948-7601
Practice Address - Street 1:800 N RAINBOW BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:702-948-7602
Practice Address - Fax:702-948-7601
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy