Healthcare Provider Details

I. General information

NPI: 1437072451
Provider Name (Legal Business Name): KEITH B. REYES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S KYRENE RD STE 4
CHANDLER AZ
85226-4687
US

IV. Provider business mailing address

4515 W TYSON ST
CHANDLER AZ
85226-2902
US

V. Phone/Fax

Practice location:
  • Phone: 480-868-7082
  • Fax:
Mailing address:
  • Phone: 480-868-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH BRIAN REYES
Title or Position: OWNER
Credential: LPC, NCC
Phone: 480-868-7082