Provider Demographics
NPI:1053044826
Name:REYNA, MANDY JEAN (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:JEAN
Last Name:REYNA
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:MRS
Other - First Name:MANDY
Other - Middle Name:JEAN
Other - Last Name:ESPARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-ASSOCIATE
Mailing Address - Street 1:1216 DUNCAN RD.
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-7409
Mailing Address - Country:US
Mailing Address - Phone:254-577-4880
Mailing Address - Fax:254-518-5300
Practice Address - Street 1:1216 DUNCAN RD.
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-7409
Practice Address - Country:US
Practice Address - Phone:254-577-4880
Practice Address - Fax:254-518-5300
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88958101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty