MEDICARE: MRS. JENNA REECE LPC

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	LPC005868	GA

General Provider Information

NPI Number	:	1619306594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA REECE LPC

Provider Business Mailing Address
First Line	:	38 TILLER WAY
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9271
Country	:	US
Telephone Number	:	912-441-8704
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 PAULSEN ST
Second Line	:	SUITE 201
City	:	SAVANNAH
State	:	GA
Zip	:	31405-4423
Country	:	US
Telephone Number	:	912-354-8108
Fax Number	:

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

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	11/01/2013

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