Provider Demographics
NPI:1912550708
Name:REYES, JENNIFER GUEVARA (MED, LPC-S, RPT-S)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GUEVARA
Last Name:REYES
Suffix:
Gender:F
Credentials:MED, LPC-S, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 CORTES PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5665
Mailing Address - Country:US
Mailing Address - Phone:512-787-2974
Mailing Address - Fax:
Practice Address - Street 1:201 S LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2718
Practice Address - Country:US
Practice Address - Phone:512-774-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty