Basic Information
| Provider Information | |||||||||
| NPI: | 1245296359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | DALIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COUNSELOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 923 S 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989024045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099616079 | ||||||||
| FaxNumber: | 5094532209 | ||||||||
| Practice Location | |||||||||
| Address1: | 918 E MEAD AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989033720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094531344 | ||||||||
| FaxNumber: | 5094532209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00011433 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.