Provider Demographics
NPI:1104401637
Name:REYES, NANCY MICHELLE (MSW, LCIASW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MICHELLE
Last Name:REYES
Suffix:
Gender:
Credentials:MSW, LCIASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 S D ST APT 4-107
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-6137
Mailing Address - Country:US
Mailing Address - Phone:415-404-0043
Mailing Address - Fax:
Practice Address - Street 1:7015 S D ST APT 4-107
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-6137
Practice Address - Country:US
Practice Address - Phone:253-200-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 171M00000X
WA615961421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator