Provider Demographics
NPI:1164791315
Name:REYES, VALERIE K (MA,IMFT,ICADC, CSAC)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:K
Last Name:REYES
Suffix:
Gender:F
Credentials:MA,IMFT,ICADC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2653
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-2653
Mailing Address - Country:US
Mailing Address - Phone:671-727-8533
Mailing Address - Fax:
Practice Address - Street 1:1244 N MARINE CORPS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4308
Practice Address - Country:US
Practice Address - Phone:671-647-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU115269101YA0400X
GUIMFT-0014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU201001568OtherGUAM BUSINESS LICENSE
GU1228074070OtherGDL