Provider Demographics
NPI:1104999275
Name:REYES, TANYA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W CENTER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7326
Mailing Address - Country:US
Mailing Address - Phone:209-645-0534
Mailing Address - Fax:209-800-5888
Practice Address - Street 1:955 W CENTER ST STE 2
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7326
Practice Address - Country:US
Practice Address - Phone:209-645-0534
Practice Address - Fax:209-800-5888
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78332106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4886OtherCOUNTY ID