Healthcare Provider Details

I. General information

NPI: 1245296359
Provider Name (Legal Business Name): MARTHA DALIA REYES COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E MEAD AVE
YAKIMA WA
98903-3720
US

IV. Provider business mailing address

923 S 29TH AVE
YAKIMA WA
98902-4045
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-1344
  • Fax: 509-453-2209
Mailing address:
  • Phone: 509-961-6079
  • Fax: 509-453-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00011433
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: