Provider Demographics
NPI:1336967421
Name:REYES, ELENA (PLMHP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S 33RD ST STE E
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5755
Mailing Address - Country:US
Mailing Address - Phone:402-225-6523
Mailing Address - Fax:
Practice Address - Street 1:3201 S 33RD ST STE E
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5755
Practice Address - Country:US
Practice Address - Phone:402-225-6523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-28
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80911041C0700X
NE13960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical