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General NPI Number Information
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NPI Number | 1306015482
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Entity Type | Individual
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Provider Name | JOSEPH M REA M.A.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 3404 W CHERYL DR SUITE A-255
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City | PHOENIX
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State | AZ
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Zip | 85051-9578
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Country | US
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Telephone | 602-548-8508
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Fax | 602-548-1201
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Provider Business Mailing Address
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Address Line | 3404 W CHERYL DR SUITE A-255
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City | PHOENIX
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State | AZ
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Zip | 85051-9578
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Country | US
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Telephone | 602-548-8508
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Fax | 602-548-1201
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LAC-12728
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License Number State | AZ
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