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General NPI Number Information
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NPI Number | 1053330522
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Entity Type | Individual
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Provider Name | WALTER WILLIAM REED III MFT
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 193 FAIRVIEW LN ST. D
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City | SONORA
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State | CA
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Zip | 95370-4828
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Country | US
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Telephone | 209-532-3569
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Fax | 209-532-4086
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Provider Business Mailing Address
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Address Line | PO BOX 301
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City | STANDARD
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State | CA
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Zip | 95373-0301
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Country | US
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Telephone | 209-532-3569
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Fax | 209-532-4086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC23141
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License Number State | CA
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