MEDICARE: ADRIAN REYES

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	103TC0700X	Clinical Psychologist	36515	TX

General Provider Information

NPI Number	:	1558770339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN REYES

Provider Business Mailing Address
First Line	:	3102 SILVER SPRINGS WAY
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75089-2866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 SILVER SPRINGS WAY
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75089-2866
Country	:	US
Telephone Number	:	804-512-4375
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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Directions to “ ADRIAN REYES ” Practice Location

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