Provider Demographics
NPI:1518216639
Name:REY, ANTONIA M (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:M
Last Name:REY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 D ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4695
Mailing Address - Country:US
Mailing Address - Phone:916-396-3497
Mailing Address - Fax:530-750-1798
Practice Address - Street 1:133 D ST
Practice Address - Street 2:SUITE J
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4695
Practice Address - Country:US
Practice Address - Phone:916-396-3497
Practice Address - Fax:530-750-1798
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist