Provider Demographics
NPI:1720429400
Name:REYES, AMARILYS (LMFT)
Entity Type:Individual
Prefix:MS
First Name:AMARILYS
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:AMA
Other - Middle Name:
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10200 SEPULVEDA BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-3322
Mailing Address - Country:US
Mailing Address - Phone:661-916-1733
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3322
Practice Address - Country:US
Practice Address - Phone:661-916-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97788OtherMFT LICENSE
CA75571OtherLICENSE