Provider Demographics
NPI:1376900886
Name:REYES, LEOPOLDO JR (CDP)
Entity Type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:
Last Name:REYES
Suffix:JR
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W YAKIMA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3473
Mailing Address - Country:US
Mailing Address - Phone:509-454-3641
Mailing Address - Fax:509-575-2915
Practice Address - Street 1:202 W YAKIMA AVE STE 200
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3473
Practice Address - Country:US
Practice Address - Phone:509-454-3641
Practice Address - Fax:509-575-2915
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006253101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)