Provider Demographics
NPI:1932166568
Name:REYES, ITZA IVONNE (CDP)
Entity type:Individual
Prefix:MRS
First Name:ITZA
Middle Name:IVONNE
Last Name:REYES
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8430 ASHUE RD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-9781
Mailing Address - Country:US
Mailing Address - Phone:509-836-4161
Mailing Address - Fax:509-837-0450
Practice Address - Street 1:918 E MEAD AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-3720
Practice Address - Country:US
Practice Address - Phone:509-836-4161
Practice Address - Fax:509-837-0450
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)