Provider Demographics
NPI:1093183154
Name:DELOS REYES, BEVERLY GRACE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BEVERLY GRACE
Middle Name:
Last Name:DELOS REYES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 GOV CARLOS G CAMACHO RD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3129
Mailing Address - Country:US
Mailing Address - Phone:671-647-5440
Mailing Address - Fax:
Practice Address - Street 1:790 GOV CARLOS G CAMACHO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULPC-147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional