Provider Demographics
NPI:1326416231
Name:REYES, MARIO (CP 60391002)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:CP 60391002
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MISSION ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6610
Mailing Address - Country:US
Mailing Address - Phone:509-888-4404
Mailing Address - Fax:509-888-2741
Practice Address - Street 1:610 N MISSION ST STE 106
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6610
Practice Address - Country:US
Practice Address - Phone:509-888-4404
Practice Address - Fax:509-888-2741
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60391002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health