Active NPI
Brenda Nahiely Reza
- Student in an Organized Health Care Education/Training Program
- Southfield, MI
National Provider Identifier
1073022802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 17320 W 12 Mile Rd
Southfield, MI 48076-2100 - Phone
- (248) 727-3456
- Fax
- (242) 557-4697
- NPI assigned
- Sep 25, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
17320 W 12 Mile Rd
Southfield, MI 48076-2100
Mailing address
17320 W 12 Mile Rd
Southfield, MI 48076-2100
Phone (248) 727-3456
Other practice location 1
9445 Farnham St.
Suite 100
San Diego, CA 92123
Phone (619) 980-9312
Other names 1
- Brenda Nahiely Hernandez Jimenez
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southfield Mental Health Associates PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Southfield, MI
- NPI 1619015872
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666224000000",
"number": "1073022802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17320 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480762100",
"telephone_number": "248-727-3456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17320 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480762100",
"telephone_number": "248-727-3456",
"fax_number": "242-557-4697"
}
],
"practiceLocations": [
{
"address_1": "9445 Farnham St.",
"address_2": "Suite 100",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "92123",
"country_code": "US",
"telephone_number": "619-980-9312",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REZA",
"first_name": "BRENDA NAHIELY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-25",
"last_updated": "2022-10-20",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BRENDA NAHIELY",
"last_name": "HERNANDEZ JIMENEZ",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.