MEDICARE: MR. GERALD EDWARD REASON JR. L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701003815	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O801438	OTHER	VA	EAP PROVIDER NUMBER
2	O802641M	OTHER	VA	SENTARA PROVIDER NUMBER
3	196627	OTHER	VA	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1376663385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD EDWARD REASON JR. L.P.C.

Provider Business Mailing Address
First Line	:	4417 CORPORATION LN
Second Line	:	SUITE 250
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3162
Country	:	US
Telephone Number	:	757-687-6334
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 CORPORATION LN
Second Line	:	SUITE 250
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3162
Country	:	US
Telephone Number	:	757-687-6334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	07/08/2007

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