Provider Demographics
NPI:1588829634
Name:REYES, CARLA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:REYES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3847 E BROCKBANK DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3956
Mailing Address - Country:US
Mailing Address - Phone:801-232-5363
Mailing Address - Fax:801-274-0889
Practice Address - Street 1:4568 S HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4234
Practice Address - Country:US
Practice Address - Phone:801-232-5363
Practice Address - Fax:801-274-0889
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT98-346259-2501103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent