Basic Information
| Provider Information | |||||||||
| NPI: | 1013495159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LISA REYES SOCIAL WORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9309 W KINGFISHER DR | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571073050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056106307 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9309 W KINGFISHER DR | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571073050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056106307 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2018 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| AuthorizedOfficialLastName: | REYES | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6056106307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3135 | SD | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.