Healthcare Provider Details

I. General information

NPI: 1477978252
Provider Name (Legal Business Name): JOHN DAVID REID MS, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W WASHINGTON ST RM W353
INDIANAPOLIS IN
46204-2779
US

IV. Provider business mailing address

402 W WASHINGTON ST RM W353
INDIANAPOLIS IN
46204-2779
US

V. Phone/Fax

Practice location:
  • Phone: 317-233-4714
  • Fax:
Mailing address:
  • Phone: 317-233-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002569A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: