MEDICARE: MARTHA JACKELINE REYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI0155	NV

General Provider Information

NPI Number	:	1861721151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA JACKELINE REYES

Provider Business Mailing Address
First Line	:	1410 HOMETOWN AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8704
Country	:	US
Telephone Number	:	702-481-1786
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 WESTCLIFF DR
Second Line	:	MODULAR 8103
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-3958
Country	:	US
Telephone Number	:	702-673-4745
Fax Number	:	702-673-4771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	03/24/2010

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Directions to “ MARTHA JACKELINE REYES ” Practice Location

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