Provider Demographics
NPI:1306901152
Name:REYES, ALEJANDRO ALFREDO (LCSW78802)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ALFREDO
Last Name:REYES
Suffix:
Gender:M
Credentials:LCSW78802
Other - Prefix:
Other - First Name:ALEJANDRO
Other - Middle Name:ALFREDO
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW78802
Mailing Address - Street 1:44199 MONROE ST STE C
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3094
Mailing Address - Country:US
Mailing Address - Phone:760-863-2578
Mailing Address - Fax:
Practice Address - Street 1:46900 MONROE ST STE 101
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4828
Practice Address - Country:US
Practice Address - Phone:760-863-7219
Practice Address - Fax:760-863-8777
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW788021041C0700X
104100000X
CAASW63298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker