Provider Demographics
NPI:1891558029
Name:PACHECO, REYES (PCSW)
Entity Type:Individual
Prefix:
First Name:REYES
Middle Name:
Last Name:PACHECO
Suffix:
Gender:M
Credentials:PCSW
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1221 IVY LN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3065
Mailing Address - Country:US
Mailing Address - Phone:307-258-1226
Mailing Address - Fax:
Practice Address - Street 1:1514 E 12TH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4080
Practice Address - Country:US
Practice Address - Phone:307-258-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)