Provider Demographics
NPI:1124209846
Name:REYES, EDWINA L (MFT)
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:L
Last Name:REYES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-512 HAKEA PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4761
Mailing Address - Country:US
Mailing Address - Phone:808-688-2812
Mailing Address - Fax:
Practice Address - Street 1:92-6043 MAKEKE ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2361
Practice Address - Country:US
Practice Address - Phone:808-226-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist