Basic Information
| Provider Information | |||||||||
| NPI: | 1831650290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | MELANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3238 LANGE ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982779224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183342700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 231 SE BARRINGTON DR STE 203 | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982773200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662400808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101Y00000X | CG60947834 | WA | N | Behavioral Health & Social Service Providers | Counselor | 106E00000X | AB61311197 | WA | Y |
No ID Information.