Provider Demographics
NPI:1922825165
Name:PEAK PERFORMANCE MINDSET COY REYES LICENSED CLINICAL SOCIAL WORKER
Entity type:Organization
Organization Name:PEAK PERFORMANCE MINDSET COY REYES LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COY
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:747-218-3106
Mailing Address - Street 1:350 N GLENDALE AVE STE B #323
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3323
Mailing Address - Country:US
Mailing Address - Phone:747-218-3106
Mailing Address - Fax:
Practice Address - Street 1:350 N GLENDALE AVE STE B #323
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3323
Practice Address - Country:US
Practice Address - Phone:747-218-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty