Provider Demographics
NPI:1043595556
Name:REYES, MIRIAM C (BS)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:C
Last Name:REYES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 S 259TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-9043
Mailing Address - Country:US
Mailing Address - Phone:702-841-4058
Mailing Address - Fax:
Practice Address - Street 1:1909 S 259TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-9043
Practice Address - Country:US
Practice Address - Phone:702-841-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV830395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV830395Other830395