MEDICARE: VICTORIA REYNA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	79846	TX
2	106S00000X	Behavior Technician	RBT-18-67139	TX

General Provider Information

NPI Number	:	1396210381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA REYNA LPC

Provider Business Mailing Address
First Line	:	12501 ROBERT DAVID DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-1755
Country	:	US
Telephone Number	:	915-740-0383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N LEE TREVINO DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5169
Country	:	US
Telephone Number	:	915-593-5676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	03/19/2020

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Directions to “ VICTORIA REYNA LPC” Practice Location

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