Provider Demographics
NPI:1033579339
Name:REYES CORPORATION
Entity Type:Organization
Organization Name:REYES CORPORATION
Other - Org Name:CREATIVE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MAC,LPC,LAC,BC-TMH
Authorized Official - Phone:970-221-4057
Mailing Address - Street 1:1437 DENVER AVE # 325
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5226
Mailing Address - Country:US
Mailing Address - Phone:970-222-7986
Mailing Address - Fax:
Practice Address - Street 1:1601 25TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4907
Practice Address - Country:US
Practice Address - Phone:970-378-8805
Practice Address - Fax:970-378-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1595-05251S00000X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78182573Medicaid