Basic Information
| Provider Information | |||||||||
| NPI: | 1306145214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSW, CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9309 W KINGFISHER DR | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571073050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056106307 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2501 W 22ND ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053363230 | ||||||||
| FaxNumber: | 6053335387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2011 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2413 | SD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 3135 | SD | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 2413 | 01 | SD | LICENSED CERTIFIED SOCIAL WORKER | OTHER |