Individual
FIDEL REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 MEDICAL DR STE D101, BOUNTIFUL, UT 84010-8905
(385) 202-5481
(801) 951-5399
Mailing address
6013 S REDWOOD RD, TAYLORSVILLE, UT 84123-5220
(801) 255-5131
(801) 658-0604
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
Primary
RBT-18-64828
UT
Other
Enumeration date
02/05/2018
Last updated
07/23/2020
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