1720236961 NPI number — MRS. LEIANA MARIE REYES LMFT

Table of content: MRS. LEIANA MARIE REYES LMFT (NPI 1720236961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720236961 NPI number — MRS. LEIANA MARIE REYES LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
LEIANA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720236961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4443
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-0443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-937-4363
Provider Business Mailing Address Fax Number:
808-966-4689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 AUPUNI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-937-4363
Provider Business Practice Location Address Fax Number:
808-966-4689
Provider Enumeration Date:
08/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  306 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)