Healthcare Provider Details

I. General information

NPI: 1700539160
Provider Name (Legal Business Name): KEITH BRIAN REYES LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
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: 520-200-3851
  • Fax:
Mailing address:
  • Phone: 480-262-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: