Doctor Name: | MR. EDWARD C REYES |
NPI Number: | 1578974416 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LPC |
License Number: | 69846 |
Business Practice Address: | 1715 Fm 1626 Manchaca, TX - 786523553 |
Business Phone Number: | 2103933342 |
Business Fax Number: | |
Mailing Address: | 5921 Red Bud Ridge Lane, AUSTIN |
State: | TX |
Postal Code: | 78744 |
Phone Number: | 2103933342 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2014 |
NPI Last Update Date: | 05/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 69846 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |