Provider Demographics
NPI:1386157212
Name:REYES, PE'SHANCE (CADC)
Entity type:Individual
Prefix:
First Name:PE'SHANCE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 VASSAR ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3224
Mailing Address - Country:US
Mailing Address - Phone:775-448-6533
Mailing Address - Fax:775-787-2751
Practice Address - Street 1:9498 DOUBLE R BLVD STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2905
Practice Address - Country:US
Practice Address - Phone:775-964-4898
Practice Address - Fax:866-356-7299
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-17-42739106S00000X
NV07466-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician