Provider Demographics
NPI:1043043664
Name:REYNA, LETICIA ALEJANDRA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:ALEJANDRA
Last Name:REYNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 N LOOP 1604 E APT 11308
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2840
Mailing Address - Country:US
Mailing Address - Phone:956-251-4263
Mailing Address - Fax:
Practice Address - Street 1:5002 N LOOP 1604 E APT 11308
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2840
Practice Address - Country:US
Practice Address - Phone:956-251-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health