Provider Demographics
NPI:1780830091
Name:HANUSA, HEIDI (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:HANUSA
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3735
Mailing Address - Country:US
Mailing Address - Phone:702-370-4244
Mailing Address - Fax:
Practice Address - Street 1:1016 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3735
Practice Address - Country:US
Practice Address - Phone:702-877-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVR07042106H00000X
R07042101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health