Provider Demographics
NPI:1780644815
Name:REYNA, JOHN (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:REYNA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:211 16TH AVENUE NORTH
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-467-4431
Mailing Address - Fax:208-467-7684
Practice Address - Street 1:1224 1ST STREET NORTH
Practice Address - Street 2:SUITE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3900
Practice Address - Country:US
Practice Address - Phone:208-463-2314
Practice Address - Fax:208-463-4390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional