Provider Demographics
NPI:1164914248
Name:REILLY, SASHA NICOLE
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:NICOLE
Last Name:REILLY
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 1:7906 CLEARMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6294
Mailing Address - Country:US
Mailing Address - Phone:806-672-8071
Mailing Address - Fax:
Practice Address - Street 1:7906 CLEARMEADOW DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6294
Practice Address - Country:US
Practice Address - Phone:806-672-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional