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General NPI Number Information
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NPI Number | 1598195224
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Entity Type | Individual
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Provider Name | ANALISA REYES LCSW, LCDC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 1011 MEREDITH DR STE 12
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City | AUSTIN
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State | TX
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Zip | 78748-3763
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Country | US
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Telephone | 512-703-0642
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Fax | 512-515-3089
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Provider Business Mailing Address
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Address Line | PO BOX 734
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City | MANCHACA
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State | TX
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Zip | 78652-0734
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12526
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 58367
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License Number State | TX
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