Healthcare Provider Details

I. General information

NPI: 1164791315
Provider Name (Legal Business Name): VALERIE K REYES MA,IMFT,ICADC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 07/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 N MARINE CORPS DR SUITE 101
TAMUNING GU
96913-4308
US

IV. Provider business mailing address

PO BOX 2653
HAGATNA GU
96932-2653
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-8262
  • Fax:
Mailing address:
  • Phone: 671-727-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number115269
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMFT-0014
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: