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General NPI Number Information
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NPI Number | 1952893752
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Entity Type | Individual
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Provider Name | LOURDES REYES
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 11/02/2024
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Provider Practice Location Address
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Address Line | 5353 N UNION BLVD STE 202
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-2069
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Country | US
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Telephone | 970-310-3406
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Fax | 888-965-4615
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Provider Business Mailing Address
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Address Line | 800 S ELDORADO ROAD STE 300
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City | BLOOMINGTON
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State | IL
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Zip | 61704
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Country | US
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Telephone | 331-529-6833
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Fax | 315-296-8333
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149027248
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License Number State | IL
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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 | CSW.09930791
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150104570
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License Number State | IL
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