Provider Demographics
NPI:1275634875
Name:REYES, AURORA (LPC)
Entity Type:Individual
Prefix:MS
First Name:AURORA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 ARDENNES WAY
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-8057
Mailing Address - Country:US
Mailing Address - Phone:435-228-8550
Mailing Address - Fax:
Practice Address - Street 1:SALT LAKE COUNTY SUBSTANCE ABUSE
Practice Address - Street 2:2001 SOUTH STATE ST # S -2300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84190-2250
Practice Address - Country:US
Practice Address - Phone:801-468-2011
Practice Address - Fax:801-468-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360545-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional