Healthcare Provider Details

I. General information

NPI: 1245029578
Provider Name (Legal Business Name): ANTHONY REESE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 W PEORIA AVE
PHOENIX AZ
85029-4709
US

IV. Provider business mailing address

5312 E HOLMES AVE
MESA AZ
85206-5508
US

V. Phone/Fax

Practice location:
  • Phone: 602-622-1178
  • Fax:
Mailing address:
  • Phone: 623-565-8342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLIAC-155364
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: