Healthcare Provider Details

I. General information

NPI: 1255920617
Provider Name (Legal Business Name): VANESSA REYES, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 CANOBIE AVE
WHITTIER CA
90601-2854
US

IV. Provider business mailing address

PO BOX 707
WHITTIER CA
90608-0707
US

V. Phone/Fax

Practice location:
  • Phone: 562-712-4571
  • Fax:
Mailing address:
  • Phone: 562-712-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number134005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: