Healthcare Provider Details

I. General information

NPI: 1366775504
Provider Name (Legal Business Name): SUSAN V. REYES-TORRES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN V REYES-GARCIA

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW ARCTIC DR
BEAVERTON OR
97005-9447
US

IV. Provider business mailing address

2636 SW 186TH PL
ALOHA OR
97003-3559
US

V. Phone/Fax

Practice location:
  • Phone: 503-224-2184
  • Fax:
Mailing address:
  • Phone: 626-607-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberM-08186
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-08186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: