Healthcare Provider Details

I. General information

NPI: 1780547745
Provider Name (Legal Business Name): JOSHUA DANIEL REITER SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 WESTGATE
PENDLETON OR
97801-9613
US

IV. Provider business mailing address

411 SE 11TH ST
PENDLETON OR
97801-2697
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-8721
  • Fax:
Mailing address:
  • Phone: 541-240-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: