Provider Demographics
NPI:1659250173
Name:REYNA RODRIGUEZ, NATALIE VICTORIA
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:VICTORIA
Last Name:REYNA RODRIGUEZ
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 1:11071 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2604
Mailing Address - Country:US
Mailing Address - Phone:402-932-8884
Mailing Address - Fax:402-932-8885
Practice Address - Street 1:11071 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2604
Practice Address - Country:US
Practice Address - Phone:402-932-8884
Practice Address - Fax:402-932-8885
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health