Provider Demographics
NPI:1154839041
Name:REYES, JARREN
Entity Type:Individual
Prefix:
First Name:JARREN
Middle Name:
Last Name:REYES
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 1:84-1111 LAHAINA ST APT C
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2277
Mailing Address - Country:US
Mailing Address - Phone:808-783-6850
Mailing Address - Fax:808-600-5999
Practice Address - Street 1:84-1111 LAHAINA ST APT C
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2277
Practice Address - Country:US
Practice Address - Phone:808-783-6850
Practice Address - Fax:808-600-5999
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-16-24563106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician