Provider Demographics
NPI:1346072402
Name:REYES, JEREMY (RBT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 KUPUOHI ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-2714
Mailing Address - Country:US
Mailing Address - Phone:808-446-4561
Mailing Address - Fax:855-940-3108
Practice Address - Street 1:40 KUPUOHI ST STE 206
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2714
Practice Address - Country:US
Practice Address - Phone:808-446-4561
Practice Address - Fax:855-940-3108
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician