Basic Information
Provider Information
NPI: 1386904282
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REY
FirstName: ZOILA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LMHC, CAP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2995 DREW ST FL 3
Address2:  
City: CLEARWATER
State: FL
PostalCode: 337593012
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 12512 BRUCE B DOWNS BLVD
Address2:  
City: TAMPA
State: FL
PostalCode: 33612
CountryCode: US
TelephoneNumber: 8139778700
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/24/2012
LastUpdateDate: 10/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH 11195FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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