Provider Demographics
NPI:1811048796
Name:REYES, ENRIQUE E (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:E
Last Name:REYES
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N. MESA
Mailing Address - Street 2:SUITE F-4
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6187
Mailing Address - Country:US
Mailing Address - Phone:915-544-6586
Mailing Address - Fax:915-544-6004
Practice Address - Street 1:4700 N. MESA
Practice Address - Street 2:SUITE F-4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6187
Practice Address - Country:US
Practice Address - Phone:915-544-6586
Practice Address - Fax:915-544-6004
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5037101Y00000X
TX2373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026058001Medicaid
TX5037OtherCRIME VICTIMS COMP
TX3419LCOtherBC BS