Provider Demographics
NPI:1831456136
Name:GUGINO, SHAYNA KM
Entity type:Individual
Prefix:MRS
First Name:SHAYNA
Middle Name:KM
Last Name:GUGINO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHAYNA
Other - Middle Name:KM
Other - Last Name:YAMASHIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-359-9899
Mailing Address - Fax:
Practice Address - Street 1:526 S TONOPAH DR
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4043
Practice Address - Country:US
Practice Address - Phone:702-359-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0104101YM0800X
NV01671-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)