Provider Demographics
NPI:1417607243
Name:REYES, KRISTIN MICHELLE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:REYES
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 1:9575 GAYLES CIR
Mailing Address - Street 2:
Mailing Address - City:STAGECOACH
Mailing Address - State:NV
Mailing Address - Zip Code:89429-9548
Mailing Address - Country:US
Mailing Address - Phone:916-342-2706
Mailing Address - Fax:
Practice Address - Street 1:1200 E STAN SCHLUETER LOOP STE 107
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5482
Practice Address - Country:US
Practice Address - Phone:254-833-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician