Healthcare Provider Details

I. General information

NPI: 1619135704
Provider Name (Legal Business Name): REECE OLLEY RAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 OLD ROUTE 119 HWY N
INDIANA PA
15701-1372
US

IV. Provider business mailing address

793 OLD ROUTE 119 HWY N
INDIANA PA
15701-1372
US

V. Phone/Fax

Practice location:
  • Phone: 724-465-5576
  • Fax:
Mailing address:
  • Phone: 724-465-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMI-6301012146
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS017167
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: