Healthcare Provider Details

I. General information

NPI: 1194788133
Provider Name (Legal Business Name): ANDREW J REED PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 PHYSICIANS CT
EVANSVILLE IN
47715-4031
US

IV. Provider business mailing address

PO BOX 15040
EVANSVILLE IN
47716-0040
US

V. Phone/Fax

Practice location:
  • Phone: 812-454-5457
  • Fax: 812-471-9282
Mailing address:
  • Phone: 812-476-1367
  • Fax: 812-477-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040384
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: