Healthcare Provider Details

I. General information

NPI: 1396190930
Provider Name (Legal Business Name): REED BEHAVIOR SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 SW BOND AVE UNIT 1816
PORTLAND OR
97239-4576
US

IV. Provider business mailing address

3720 SW BOND AVE UNIT 1816
PORTLAND OR
97239-4576
US

V. Phone/Fax

Practice location:
  • Phone: 530-524-8729
  • Fax:
Mailing address:
  • Phone: 530-524-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA REED
Title or Position: OWNER
Credential: M.A., BCBA, LBA
Phone: 530-524-8729