Fidel Reyes

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-18-64828 Issued in UT

Practice address

415 Medical Dr Ste D101
Bountiful, UT 84010-8905

Phone

(385) 202-5481

Fax

(801) 951-5399

NPI assigned

Feb 5, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Neurobehavioral Center for Growth LLC

  • Psychologist
  • Bountiful, UT
  • NPI 1942641931

  Multi-Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1659870681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6013 S REDWOOD RD",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841235220",
            "telephone_number": "801-255-5131",
            "fax_number": "801-658-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE D101",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840108905",
            "telephone_number": "385-202-5481",
            "fax_number": "801-951-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES",
        "first_name": "FIDEL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-05",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "UT",
            "license": "RBT-18-64828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Genesis D Reverol
• Kathryn Evelyn Irene Reynolds
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• Talmage Rhead, PA-C
• Marilyn Rice
• Richard King Mower, PH.D.,P.C.

• Behavior Technician in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Behavior Technician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.