Individual
JORGE DOMINGO REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
5700 E. FRANKLIN RD., SUITE 220-I, NAMPA, ID 83687
(208) 514-9497
Mailing address
995 N. WORLD CUP LN, EAGLE, ID 83616
(208) 514-9497
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC-5723
ID
101YP2500X
Professional Counselor
Primary
LPC-5723
ID
Other
Enumeration date
09/23/2014
Last updated
04/01/2016
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