Provider Demographics
NPI:1083482186
Name:REYES-GILPIN, CLARE ELLESSE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:ELLESSE
Last Name:REYES-GILPIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 DEL NORTE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3405
Mailing Address - Country:US
Mailing Address - Phone:626-340-8238
Mailing Address - Fax:
Practice Address - Street 1:10930 DEL NORTE ST APT 1
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-3405
Practice Address - Country:US
Practice Address - Phone:626-340-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst