Provider Demographics
NPI:1689121428
Name:REYES, CARLA RUTH (LPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RUTH
Last Name:REYES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3334
Mailing Address - Country:US
Mailing Address - Phone:630-815-3021
Mailing Address - Fax:
Practice Address - Street 1:1109 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3334
Practice Address - Country:US
Practice Address - Phone:630-815-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional