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General NPI Number Information
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NPI Number | 1316288954
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Entity Type | Individual
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Provider Name | MELANIE REYES
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Gender | Female
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 594 N GLASSELL ST
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City | ORANGE
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State | CA
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Zip | 92867-6748
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Country | US
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Telephone | 949-424-3717
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 883
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City | ORANGE
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State | CA
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Zip | 92856-6883
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Country | US
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Telephone | 949-424-3717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 72709
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 92642
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License Number State | CA
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