Healthcare Provider Details

I. General information

NPI: 1427000678
Provider Name (Legal Business Name): JAMES R EADS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 E CENTRAL TEXAS EXPY STE 111
KILLEEN TX
76543-5276
US

IV. Provider business mailing address

PO BOX 938
KILLEEN TX
76540-0938
US

V. Phone/Fax

Practice location:
  • Phone: 254-699-7222
  • Fax: 254-699-7309
Mailing address:
  • Phone: 254-634-6999
  • Fax: 254-200-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberS04015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: