Provider Demographics
NPI:1073188165
Name:PRITCHARD, RESHAY MICHEL
Entity type:Individual
Prefix:
First Name:RESHAY
Middle Name:MICHEL
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RESHAY
Other - Middle Name:CHESIREE
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1975 N SAN GORGONIO AVE
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-1935
Mailing Address - Country:US
Mailing Address - Phone:909-253-3163
Mailing Address - Fax:
Practice Address - Street 1:31946 MISSION TRL STE B
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4539
Practice Address - Country:US
Practice Address - Phone:951-245-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 175T00000X
CAMPSS-QETCBN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator