Healthcare Provider Details

I. General information

NPI: 1013165893
Provider Name (Legal Business Name): JEAN C REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date: 08/19/2010
Reactivation Date: 02/02/2011

III. Provider practice location address

2550 W CLINTON AVE
FRESNO CA
93705-4201
US

IV. Provider business mailing address

6237 W MINARETS AVE
FRESNO CA
93722-2848
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 805-781-3535
  • 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:
Title or Position:
Credential:
Phone: