Healthcare Provider Details

I. General information

NPI: 1356370761
Provider Name (Legal Business Name): THERESA M REED PHD PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W FRONT ST STE 309
MISSOULA MT
59802-4011
US

IV. Provider business mailing address

119 W FRONT ST STE 309
MISSOULA MT
59802-4011
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-6663
  • Fax: 406-327-9987
Mailing address:
  • Phone: 406-327-6663
  • Fax: 406-327-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number346
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: