Provider Demographics
NPI:1760802060
Name:REYES, TINA DENISE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:DENISE
Last Name:REYES
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N WICKHAM RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2369
Mailing Address - Country:US
Mailing Address - Phone:321-405-2751
Mailing Address - Fax:321-208-8119
Practice Address - Street 1:3040 N WICKHAM RD STE 5
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-405-2751
Practice Address - Fax:321-208-8119
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11247101YM0800X
FLMH14899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health