Healthcare Provider Details

I. General information

NPI: 1437455425
Provider Name (Legal Business Name): DR. BARRAZA-REYES, PHD, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W WHITTIER BLVD SUITE 23
LA HABRA CA
90631-3893
US

IV. Provider business mailing address

121 W WHITTIER BLVD SUITE 23
LA HABRA CA
90631-3893
US

V. Phone/Fax

Practice location:
  • Phone: 562-697-9796
  • Fax: 562-697-9787
Mailing address:
  • Phone: 562-697-9796
  • Fax: 562-697-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY20336
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY20336
License Number StateCA

VIII. Authorized Official

Name: DR. YVETTE BARRAZA-REYES
Title or Position: DIRECTOR
Credential: PHD
Phone: 562-697-9796