Provider Demographics
NPI:1679217921
Name:REYES SANCHEZ, GUSTAVO SALATHIEL (LMSW, CADC, CSW-I)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:SALATHIEL
Last Name:REYES SANCHEZ
Suffix:
Gender:M
Credentials:LMSW, CADC, CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2342
Mailing Address - Country:US
Mailing Address - Phone:702-701-4488
Mailing Address - Fax:
Practice Address - Street 1:1120 SHADOW LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2342
Practice Address - Country:US
Practice Address - Phone:702-701-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11294-M104100000X
NV1041C0700X
NV07877-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical