Healthcare Provider Details

I. General information

NPI: 1235352832
Provider Name (Legal Business Name): TINA MARIE REISING PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 BONHOMME AVE SUITE 1700
CLAYTON MO
63105-1911
US

IV. Provider business mailing address

7777 BONHOMME AVE SUITE 1700
CLAYTON MO
63105-1911
US

V. Phone/Fax

Practice location:
  • Phone: 314-725-1515
  • Fax: 314-725-1654
Mailing address:
  • Phone: 314-725-1515
  • Fax: 314-725-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2003017954
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: