Provider Demographics
NPI:1063620235
Name:NAULT, WENDY R (M S, MFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:NAULT
Suffix:
Gender:F
Credentials:M S, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 SCHUSTER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7752
Mailing Address - Country:US
Mailing Address - Phone:702-458-5697
Mailing Address - Fax:702-451-9451
Practice Address - Street 1:8720 SCHUSTER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7752
Practice Address - Country:US
Practice Address - Phone:702-458-5697
Practice Address - Fax:702-451-9451
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0298OtherMFT LICENSE