Provider Demographics
NPI:1063603744
Name:REYNA, MARY LOU (LPC)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:LOU
Last Name:REYNA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W NOLANA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3029
Mailing Address - Country:US
Mailing Address - Phone:956-688-6229
Mailing Address - Fax:956-688-6218
Practice Address - Street 1:507 W. NOLANA AVE.
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3029
Practice Address - Country:US
Practice Address - Phone:956-688-6229
Practice Address - Fax:956-688-6218
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177539701Medicaid