Healthcare Provider Details

I. General information

NPI: 1780279497
Provider Name (Legal Business Name): REESE BOYD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23412 COMMERCE PARK
BEACHWOOD OH
44122-5813
US

IV. Provider business mailing address

761 PROVIDENCE CT APT 302
STREETSBORO OH
44241-4036
US

V. Phone/Fax

Practice location:
  • Phone: 216-400-6640
  • Fax: 216-250-7016
Mailing address:
  • Phone: 740-296-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2204603
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2002868-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: