Provider Demographics
NPI:1972005551
Name:REYNA, MEILY SAMANTHA (BEHAVIOR THERAPIST)
Entity Type:Individual
Prefix:
First Name:MEILY
Middle Name:SAMANTHA
Last Name:REYNA
Suffix:
Gender:F
Credentials:BEHAVIOR THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 MOUNT GOETHE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-9079
Mailing Address - Country:US
Mailing Address - Phone:510-837-1246
Mailing Address - Fax:
Practice Address - Street 1:1858 MOUNT GOETHE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:510-837-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
171M00000X
CAY8266656171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst