Healthcare Provider Details

I. General information

NPI: 1457402885
Provider Name (Legal Business Name): RICHARD BERNARD REED ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 E 3RD ST
BLOOMINGTON IN
47401-5306
US

IV. Provider business mailing address

2115 E 3RD ST
BLOOMINGTON IN
47401-5306
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-0668
  • Fax: 812-339-5778
Mailing address:
  • Phone: 812-333-0668
  • Fax: 812-339-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20040546A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: