Healthcare Provider Details

I. General information

NPI: 1679709646
Provider Name (Legal Business Name): JEFF C REED MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N 16TH ST SUITE E-110
PHOENIX AZ
85016-5121
US

IV. Provider business mailing address

4620 N 16TH ST SUITE E-110
PHOENIX AZ
85016-5121
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-2770
  • Fax: 866-534-1701
Mailing address:
  • Phone: 602-264-2770
  • Fax: 866-534-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW - 12733
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: