Provider Demographics
NPI:1538291372
Name:REYES, SHERYL DATAYLO (MS, MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:DATAYLO
Last Name:REYES
Suffix:
Gender:F
Credentials:MS, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 E 1ST ST STE 250
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-3964
Mailing Address - Country:US
Mailing Address - Phone:323-261-4900
Mailing Address - Fax:323-261-4343
Practice Address - Street 1:2130 E 1ST ST STE 250
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3964
Practice Address - Country:US
Practice Address - Phone:323-261-4900
Practice Address - Fax:323-261-4343
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 44115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist