Healthcare Provider Details

I. General information

NPI: 1578918082
Provider Name (Legal Business Name): SCOTT REOCH LCPC-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 OCEAN AVE
PORTLAND ME
04103-5740
US

IV. Provider business mailing address

23 OCEAN AVE
PORTLAND ME
04103-5740
US

V. Phone/Fax

Practice location:
  • Phone: 207-749-8546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberXL4696
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: