MEDICARE: CONNOR REESE

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	101YM0800X	Mental Health Counselor	101YM0800X	OR

General Provider Information

NPI Number	:	1558193458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR REESE

Provider Business Mailing Address
First Line	:	PO BOX 1257
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-1257
Country	:	US
Telephone Number	:	541-535-4133
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 S. MAIN STREET, PO BOX 1257
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535
Country	:	US
Telephone Number	:	541-535-4133
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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Directions to “ CONNOR REESE ” Practice Location

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