Healthcare Provider Details

I. General information

NPI: 1184933137
Provider Name (Legal Business Name): SUSAN D REIS & ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 LEMAY FERRY ROAD
ST,. LOUIS MO
63129
US

IV. Provider business mailing address

5131 LEMAY FERRY ROAD
ST,. LOUIS MO
63129
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-0094
  • Fax: 314-846-3531
Mailing address:
  • Phone: 314-416-0094
  • Fax: 314-846-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN REIS
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 314-416-0094