Provider Demographics
NPI:1578974416
Name:REYES, EDWARD C JR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:C
Last Name:REYES
Suffix:JR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 DOVE WING CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4955
Mailing Address - Country:US
Mailing Address - Phone:210-393-3342
Mailing Address - Fax:
Practice Address - Street 1:743 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-2213
Practice Address - Country:US
Practice Address - Phone:210-999-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335291601Medicaid