Healthcare Provider Details

I. General information

NPI: 1730972803
Provider Name (Legal Business Name): MS. LAUREN DANIELLE REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S MARYLAND PKWY # 453033
LAS VEGAS NV
89154-9900
US

IV. Provider business mailing address

9110 W TROPICANA AVE UNIT 289
LAS VEGAS NV
89147-8254
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-1532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: