Provider Demographics
NPI:1689456030
Name:REYES, JUAN ANTONIO (PLADC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:REYES
Suffix:
Gender:M
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 SUNRISE PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3958
Mailing Address - Country:US
Mailing Address - Phone:402-564-9994
Mailing Address - Fax:
Practice Address - Street 1:4432 SUNRISE PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3958
Practice Address - Country:US
Practice Address - Phone:402-564-9994
Practice Address - Fax:402-562-6458
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)