Provider Demographics
NPI:1396210381
Name:REYNA, VICTORIA (LPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:REYNA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12501 ROBERT DAVID DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-1755
Mailing Address - Country:US
Mailing Address - Phone:915-740-0383
Mailing Address - Fax:
Practice Address - Street 1:1600 N LEE TREVINO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5169
Practice Address - Country:US
Practice Address - Phone:915-593-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79846101YM0800X
TXRBT-18-67139106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician